Chronic kidney disease mineral and bone disorders (CKD-MBD) is a slowly progressive complication of CKD occurring over many years. The kidneys are unable to maintain normal levels of calcium and phosphate and respond to the hormones needed to maintain healthy bones. CKD–MBD is a common problem in people with stage 3 CKD onwards and affects almost all patients receiving dialysis. This article explains why renal bone disease occurs, the problems it can cause for patients affected and provides practical tips on how to identify people at risk and management options.
Moving stroke prevention up the healthcare agenda
“There are lots of really powerful examples around o f things we can do to improve quality while improving productivity”
This statement from Sir David Nicholson, the NHS Chief Executive, appears on the NHS Evidence website, where the recognition and optimal treatment of atrial fibrillation (AF) is given as one of the top six Quality, Innovation, Productivity and Prevention (QIPP) examples from across the entire NHS.
Feeling the pinch: the impact of weight loss surgery on cardiovascular risk
Weight loss (bariatric) surgery is becoming increasingly common as the obesity epidemic continues to flourish, and recent NICE guidelines have supported this approach. In this article, we review the procedures used in bariatric surgery, the impact on patients’ cardiovascular risk and type 2 diabetes, what the guidelines recommend and the long-term care of patients who have undergone this type of surgery.
Transient ischaemic attack: act fast to reduce the risk of stroke
The White Paper, Saving lives: our healthier nation (1999), set out a target to reduce the death rate from coronary heart disease and related illnesses such as stroke by 40% in the under-75s by 2010; recent trends indicate that this target will be met. Although the past forty years have seen a significant reduction in age-standardised stroke mortality rates, stroke still accounts for around 53,000 deaths each year in the UK, with more than 9,500 of these occurring in the under-75s. This article reviews how we might reduce the huge burden of stroke by improving the management of transient ischaemic attack (TIA).
COPD: Serious, chronic and becoming more common in women
Chronic obstructive pulmonary disease (COPD) is a largely preventable, slowly progressive, inflammatory disease. Rates of COPD are rising faster in women than in men, yet women are less likely to be diagnosed. There is currently no cure, but best-practice management outlined in recently updated NICE guidelines can help to improve patients’ symptoms and quality of life.
Vaginal thrush (Candidiasis)
Training for nurses improves care for women
Many advanced nurse practitioners (ANPs) are working in innovative ways to enhance patient care in general practice. But little specific training has been available for ANPs in women’s health. This article outlines how a training course was developed specifically to improve and maintain local ANPs’ competencies in managing women’s health in primary care.
The Forum takes action as the voice for women
The Primary Care Women’s Health Forum is now over one year old. When we met to establish the Forum, we set ourselves several aims and objectives. As we celebrate our first anniversary, our membership continues to grow and we are beginning to deliver on our major objectives: to be the voice for women and improve their healthcare.
Take a sexual history in primary care
Many primary care clinicians worry about how to take an appropriate sexual history. Raising the issue seems straightforward when a woman has symptoms or when contraception or cervical screening feature in a consultation. The challenge occurs when the possibility of sexual health issues may not be so apparent to the patient.
PCOS or overweight? Solving the diagnostic dilemma
Polycystic ovary syndrome (PCOS) is the commonest endocrinopathy, affecting 5-12% of women. Every aspect has been controversial from its nomenclature to its management. But accurate diagnosis based on consensus guidelines ensures that treatment can be tailored effectively to each woman’s symptoms and needs.
Older people and HIV: A call to action
Thanks to effective treatment, people with HIV are living longer than ever. Older people are now the fastest growing group with HIV in the UK, and as many as one in five adults accessing care is now aged over 50 years. But treatment does not mean cure, and a targeted approach to support is needed, as well as action to halt the growing numbers of older women and men affected by HIV.
Intrauterine system: informed choice for women and GPs
The intrauterine system (IUS) is a very effective long-acting reversible contraceptive (LARC) for appropriate women. But myths and misconceptions may cause some patients to opt for other, less reliable or suitable methods. Addressing frequently asked questions will help GPs to prescribe with confidence and enable women to make informed decisions about their contraception.
