Many people use herbal medication of some sort, but several commonly used herbs have been shown to interact with prescribed medication. Studies show that many patients either do not realise that the herbs could interact (and anyway do not class the herbs as medicines) or do not want to tell their practitioner that they are using them. With many more nurse prescribers taking control of management of patients with longterm conditions such as diabetes and ischaemic heart disease, it is vital that we consider that the patient may be taking non-prescribed medication including herbs and supplements.
Lipid Modification in Primary Prevention – Treatment not Target
The NICE lipid modification guideline, published in May this year, covered both primary and secondary prevention of CVD. This article will look briefly at the principles of this guideline in relation to primary prevention and then go further to highlight the key issues regarding statin prescribing for people established to be at high cardiovascular risk.
Why do People with Diabetes Fall Off the Rails?
Why is it that some patients with diabetes are able to stick to the ‘straight and narrow’ while others fall off the rails? I decided to look at my client group to see if I could pick up on any particular issues that made people either forget that they have diabetes, or struggle to continue to control their blood glucose levels as they had previously been doing. This article reviews what I found and offers some suggestions on how to help patients get back in control.
Putting the NICE Guideline on Type 2 Diabetes into Practice
At last, the updated NICE (National Institute for Health and Clinical Excellence) guideline for the management of type 2 diabetes has been published. It includes an update on the management of blood glucose, blood pressure, lipids, renal function and retinopathy, but the key priorities for implementation are based on taking a patient-centred approach to care. In this article, we will focus on the important areas of patient education, dietary assessment, setting targets for HbA1c, self-monitoring and starting insulin therapy.
Making Sense of FINDRISC: the Finnish Diabetes Risk Score and How to Use it
In this article, we look at what FINDRISC is and how this tool can be used to effectively prevent and slow down the development of diabetes. We also discuss the correlation between blood glucose and cardiovascular risk before a diagnosis of diabetes has been made, and how to manage risk factors to significantly reduce morbidity and mortality.
Starting on a Gliptin – Sitagliptin or Vildagliptin
Heart Failure Specialist Nurses: Feeling the Impact
Heart Failure Specialist Nurses (HFSNs) now work in the community alongside their general practice colleagues. They can act as a valuable resource to support the primary care team in the management of heart failure patients. They carry out home visits and run community clinics to stabilise patients after discharge from hospital following an acute event. The aim is to educate patients and their family carers how to manage living with heart failure, up-titrate medications to optimal levels, stabilise the patient and then hand them back to the care of the primary care team, knowing that they will be referred back to the HFSN should their condition deteriorate. However, some complex patients with advanced heart failure (NYHA III or IV) and at high risk of re-hospitalisation are retained in the specialist nurse caseload.
Back to Basics: Making sense of peripheral arterial disease (PAD)
The penis as a barometer of cardiovascular risk
The arteries that supply the penis are very small and may be more prone to atherosclerosis than larger vessels. This means that the penis may be the first area in a man’s body to suffer from a reduction in blood flow and so signal cardiovascular disease.
Wholegrains: sorting out the wheat from the chaff
The seeds of cultivated cereal crops, or grains as they are also known, have been used as a staple of man’s diet for thousands of years. Indeed the cultivation of rye, the first cereal crop from around 10,000 BC, is credited with enabling our hunter-gatherer ancestors to form more settled, complex civilisations. Throughout most of our history we’ve eaten these grains “whole” in the form of unpolished rice or wholewheat flour, for example. It’s only in last 120 years or so that more refined milling techniques have enabled the white or refined forms of these cereal crops to become the preferred choice in much of western society. What impact does this change have for our health?
Hands on peripheral arterial disease
Peripheral arterial disease (PAD), also known as peripheral vascular disease (PVD), is a vascular condition which affects the legs. It is caused by atherosclerosis – narrowing and hardening of the arteries – and has previously been described as being similar to angina in the legs. Sufferers get cramping pains in their legs when they walk, which is relieved by rest. This is similar to the chest pain that occurs in people with coronary heart disease (CHD). The similarities between CHD and PAD do not end there: the causes and treatments also overlap. In this article, we explore how two patients presented with symptoms suggestive of PAD and how they were treated.
Using neurolinguistic programming to help patients achieve their goals
How can you help patients to achieve their goals when trying to improve their health? In this article, we explore the neurolinguistic programming (NLP) technique of defining “keys to an achievable outcome”. The theory is that the more specific you are about the goal you are aiming for, the more achievable it becomes. This follows two articles in previous issues where we examined how to develop rapport with patients using linguistics and body language effectively (see www.bjpcn.com if you missed them).
