“It is no use saying ‘We are doing our best.’ You have got to succeed in doing what is necessary.” So said Winston Churchill. His approach helped win the Second World War, and applies just as well to the war we fight every day against cardiovascular disease.
Diabetes Control During Ramadan: How to Advise our Patients
Fasting is obligatory for all Muslim men and boys over the age of 12 and for Muslim women and girls who have passed puberty. It requires that no food or drink pass the lips during the hours of daylight, including medication – oral or inhaled. Not eating or being unable to take medication during the daytime obviously has major implications for people with diabetes. In this article we review how we should advise our patients – how can they maintain control of their diabetes at the same time as honouring their religious obligations?
Blood Clotting: How do Drugs Affect it?
Haemostasis is essentially the fine balance between activators and inhibitors that control the production of the protein tangle that makes up a blood clot. A range of drugs can interfere with this fine balance. In this article we guide you through the latest theories of how blood clotting occurs and explain how various drugs used as anticoagulants interfere with this normal haemostatic mechanism.
You and Your Treatment: Starting on Metformin
Editorial
Welcome to the summer issue of BJPCN – just what you need to read on the beach! We are delighted to have a guest editorial from Dr Sue Roberts, the National Clinical Director for Diabetes, providing encouragement for the work that we, as practice nurses, do in improving the management of diabetes.
Diabetes In The Elderly
As the world population continues to age and the proportion of the elderly suffering from diabetes increases compared to other age groups, the health burden of diabetes in the elderly is set to continue to rise. Practices need to be prepared to cope with a near doubling of the number of elderly people with diabetes over the next twenty years. In this article, we review the particular challenges of managing diabetes in the older patient.
You And Your Treatment: Starting On Your ACE Inhibitor
The Role Of Varenicline In Smoking Cessation
Varenicline (Champix) is the newest, prescription-only oral drug we have to treat patients with today’s most important preventable health risk – smoking. With the 1st July deadline for no smoking in public places, there is more reason than ever for people to quit. NICE has recommended use of varenicline by the NHS in recent draft guidance, alongside counselling and support. In this article, we review how the drug fits into our strategies for helping our patients to stop smoking.
Body Mass Index (BMI) Or Waist-Hip Ratio?
The association between body mass index (BMI) and mortality from both cardiovascular disease (CVD) and coronary heart disease (CHD) is well accepted. Individuals with high BMIs are also at increased risk of developing other conditions such as sleep apnoea, osteoarthritis, female infertility, varicose veins, gastro-oesophageal reflux and stress incontinence. BMI has been the gold standard for predicting health by measuring body weight in relation to height. However, although BMI may be helpful in estimating overall obesity, it is becoming increasingly apparent that waist-hip ratio, which estimates central obesity, is a more accurate predictor of the risk of health problems generally and CVD in particular.
Back To Basics: Making sense of healthy and unhealthy fats
Peripheral Arterial Disease: The Forgotten Aspect Of CVD
Peripheral arterial disease (PAD) is emerging as being particularly important in terms of cardiovascular risk but its importance as a clear marker for serious underlying vascular disease goes largely unrecognised, with PAD being the only cardiovascular disease not included in the Quality and Outcomes Framework. PAD is often detected late, because patients tend to think that pain in their legs is simply a part of ageing. In this article, we discuss how to recognise and treat people with, or at risk of, PAD using both pharmacological and non-pharmacological interventions. We will also consider when referral to secondary care is appropriate.
Apocalypse Now: Can We Prevent The Next Generation Dying Before Their Parents?
Death rates from coronary heart disease (CHD) have halved in most industrialised countries since the 1970s and those in the UK by 44% over the last decade in people under 65. But death rates from cardiovascular disease have been falling more slowly in the UK compared to other countries, particularly in the younger age group. CHD deaths fell by 49% in men aged 55-64 but only by 30% in younger men aged 35-44 between 1994 and 2004 in the UK. In women, there was only a 20% drop in the 35-44 age group compared to a 56% fall in deaths in the older age bracket. Why are younger people doing so badly and what does this mean for their future?
