The liver has many functions, and therefore diseases of the liver have numerous consequences. These can be detected and monitored with blood tests. This article provides a review of liver function tests, or LFTs, and how they relate to the key functions of the liver and some of the most common liver diseases.
Reducing alcohol misuse and using audit tools in primary care
Excessive alcohol consumption has joined smoking and obesity as one of today’s major threats to public health. It is a major cause of liver disease, as well as a range of cancers, cardiovascular disease and mental illness. What’s the solution? We look at how primary care can identify patients who are drinking too much and what interventions can help.
British Heart Foundation – New support for GPs
The British Heart Foundation (BHF) is often seen as an organisation focused on patients. This is true, but along with major research, supporting healthcare professionals is also a vital part of our role. In the past we have worked mainly with specialists in secondary care, but now we are re-focusing our attention. For the first time, we are supporting GPs and other primary healthcare professionals with education and training, and becoming involved in projects where GPs play a central role in improving patient outcomes.
Chronic kidney disease: an increasingly recognised marker of cardiovascular risk
Richard Bright was ahead of his time in recognising the importance of being able to diagnose renal disease. Chronic kidney disease (CKD) patients can be at similar levels of cardiovascular risk to those patients who have previously had a heart attack.
Stroke and cardiovascular disease: significant progress but still much to do
In March 2012, the Department of Health created the first National Clinical Director post dedicated to stroke care. Whilst the post is an interim one, pending final decisions about the nature of clinical input to the NHS Commissioning Board from 1st April 2013, its creation emphasises the commitment of the government to continue the implementation of the National Stroke Strategy, in the context of a major emphasis on joining up cardiovascular care.
Be aware: signposting acute chest pain
The Mid and South West Wales Cardiac Network (now the South Wales Cardiac Network) identified the need to devise resources to encourage patients to dial 999, safely signposting those calling into a GP practice complaining of acute chest pain to the 999 system. The resources and educational sessions were well received, with outcomes demonstrating improvements in staff confidence, backed up with the rationale and guidance, and an improvement in those directly accessing the 999 system, with the potential to receive reperfusion more quickly, preserving myocardium.
The GRANITE project: evaluating a novel cardiovascular prevention model in Scotland
Targeted case-finding for cardiovascular disease (CVD) prevention may be preferable to universal screening. Quality Improvement Scotland (QIS) has recommended that identification of high-risk individuals is needed. In this study, probable CVD risk in patients within the 40-70 years age range who were not on the CHD, Diabetes and Stroke registers and who were not already receiving statins was analysed using a predictive software toolkit which utilised the ASSIGN risk calculator. This programme effectively identified a patient population with a probable high 10-year CVD risk requiring intervention for CVD prevention after clinical assessment.
The varicose vein consultation: an aide-mémoire
Varicose veins affect about 25% of adults in the UK,1 with roughly equal prevalence in men and women, although women are more likely to present. Approximately 50% of varicosities involve the great saphenous vein (GSV), 30% the short saphenous vein (SSV), and 20% both.2 Patients may present to primary care with aesthetic concerns, or with symptoms including night cramps, itching, mild swelling of the ankles or a dull ache in the legs (usually exacerbated by standing for long periods and worse at night). The motivation for presentation should be sought as this will guide your management strategy.3 Varicosity size may not correlate with the severity of symptoms as reported by the patient.
Attitudes to taking medications for cardiovascular disease prevention
Cardiovascular disease prevention is one of the main challenges facing primary care today. In order to reduce the burden of disease, national guidelines recommend that asymptomatic patients who are at high risk of cardiovascular disease should be offered preventive medications. This article discusses cardiovascular disease risk assessment, communication of this risk to patients and attitudes of both general practitioners and patients to preventive medications.
Statin prescribing in Europe: a comparison of differences and potential impact on health outcomes
The benefit of treatment with HMG-CoA reductase inhibitors (statins) is unquestioned, with multiple studies over the last 20 years having shown that statins improve cardiovascular (CV) outcomes.1 Although all statins reduce low-density lipoprotein cholesterol (LDL-C), their potencies differ. The decreasing order of potency (per milligram) for LDL-C reduction is: rosuvastatin, atorvastatin, simvastatin and pravastatin.
Integration of cardiac services
Prominent consequences of the Health and Social Care Act which has now passed into law will be the increased commissioning of cardiac services and changes in how they are delivered. This Act, although establishing an NHS Commissioning Board to provide commissioning guidance, intends to increase markedly GPs’ power to commission services. Monitor, the non-departmental public body, will be developed into an economic regulator to oversee access and competition within the NHS
Selecting the right patients for the new agents
Who should be treated with these new agents? When should patients be switched from warfarin or aspirin?
Dr Matthew Fay
GP and National Clinical Lead for Atrial Fibrillation, Westcliffe Medical Centre, Shipley
Dr Frances Akinwunmi
Consultant Pharmacist (Anticoagulation), Imperial College Healthcare NHS Trust
