The focus of diabetes care is well established in general practice, with practice nurses taking on much of the responsibility for diabetes management. The white paper Our Health, Our Care, Our Say talks about high quality care being delivered to patients close to where they live. So, in the future, general practice can expect to take on more responsibility for conditions such as diabetes. This article discusses the priorities for the newly diagnosed patient, and the importance of sound advice and guidance in the early stages.
Organising Care For The Person Newly Diagnosed With Diabetes
Successful combining of antihypertensive drugs
Hypertension (high blood pressure) is estimated to affect 60-70% of people aged over 60 years of age and increases the risk of complications such as coronary heart disease, heart failure and stroke. Although it is well accepted that lowering blood pressure is crucial in reducing overall cardiovascular morbidity and mortality, the number of people whose raised blood pressure is reduced below target levels remains defiantly low. In this article, we review why so many patients fail to reach blood pressure targets and how we can improve this, including use of more than one antihypertensive.
Back to Basics: Diabetic foot guide
Nurse Prescribing: Pandora’s Box or Practical Plan?
Nurse prescribers can prescribe the full range of drugs and other items in the British National Formulary under the latest arrangements from the Department of Health. This move has been met with mixed reactions. Nurses see it as the rightful acknowledgement of their responsibilities, conferring authority commensurate with their role and enabling them to perform their role honestly and openly. In contrast, the British Medical Association, representing doctors, issued public warnings about patient safety if nurses were allowed to prescribe more freely. In this article, we review the opportunities and challenges of nurse prescribing, and explore strategies for its effective and safe implementation.
Heart Murmurs – When Are They Significant?
Heart murmurs – abnormal sounds heard through the stethoscope – are caused by turbulent blood flow in the heart or blood vessels. They can be associated with a range of conditions, including valve defects, high blood pressure and heart failure in adults and congenital heart defects in children. Patients should be investigated carefully to identify the underlying cause, which will determine treatment and prognosis. Some pathological murmurs require no treatment. If they are severe, however, surgery may be needed to correct the causative defect. Drug treatments may be indicated for some murmurs.
Editorial
I am keeping my fingers crossed as I write this that you are all having to apply sun protection factor 30 as a result of a glorious summer and that you are enjoying reading this issue of British Journal of Primary Care Nursing to the accompaniment of gently chinking ice cubes as drinks are served to you while you recline under a parasol! Well it was a nice thought!
The NICE Guidance On Statins – What’s New?
It would be easy to think that there was no more progress for statins to make. Since the publication of the landmark 4S study in the early 1990s, statins have become one of the most commonly prescribed drugs in the UK. But the recent publication of new NICE guidance on statins, and the second Joint British Societies guidance on cholesterol management for prevention of cardiovascular disease (JBS2) have changed the rules yet again. Under their recommendations, millions more patients become eligibile for statins to reduce their cholesterol.
What is New in the QOF?
The Quality and Outcomes Framework (QOF) has been a huge success and primary care in the UK is now delivering some of the best results in the world for the management of chronic disease. The Department of Health is obviously keen to continue to drive up quality in existing domains and extend the QOF to new areas of health care, with an updated list of indicators published earlier this year. In this article we explore what has changed.
Managing Hypertension: Updated NICE Guideline
Screening for Depression in the Cardiovascular Disease Clinic
The revised new GMS contract recommends that we screen patients with coronary heart disease (CHD) and diabetes for depression. This is evidence-based, as we know that people with long-term conditions are at high risk of anxiety and depression; but who is going to do it, how is it done and when do we find the time? It would seem obvious to include some sort of screening process in the annual CHD or diabetes review – but is this feasible? In this article we review practical ways of screening for depression in patients with CHD and diabetes.
Functional Foods: More Than Just Good To Eat
There has been a flurry of interest in functional foods over the past few months. Health claims range from lowering cholesterol to improving vitality. Functional foods have been popular in the Far East for many years but only arrived in the UK six years ago. They are now the most rapidly growing sector of the food industry, with estimates suggesting we currently spend around £1 million on them every day. To make informed choices, consumers and health professionals need to know the truth behind the hype. In this article we review the range of functional foods now available, take a look at the evidence for their claims and explore the pros and cons of using them.
