Improving the management and prevention of stroke is a priority for the NHS. Atrial fibrillation (AF) is widely recognised to be a major cause of stroke. Moreover, it is a preventable cause in that the increased risk of stroke associated with AF can be markedly reduced by anticoagulation with warfarin. Yet a substantial number of cases of AF remain undetected and untreated. Of more concern, even after identification of AF, many individuals at high risk of stroke do not receive warfarin. This article reviews the evidence on the importance of AF as a cause of stroke and assesses the benefits of anticoagulation and our reluctance to anticoagulate. Finally, it explores ways of improving on current practice, to increase the proportion of patients with AF receiving anticoagulants.
The care of pre-existing diabetes during pregnancy is complex and the remit of secondary care, but much can be done by primary care staff to ensure that pregnant women and their babies are safely on the right track by the time pregnancy is confirmed. In this article, we explore how to provide women with pre-existing diabetes with detailed and accurate preconceptual advice. Work needs to begin before contraception is discontinued to significantly reduce the risks for both mother and baby. In women with gestational diabetes, practice nurses can also be proactive postnatally, preventing progression to type 2 diabetes.
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?
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).
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.
Chronic kidney disease (CKD) is common, harmful and treatable. The recognition of CKD as a public health problem has evolved, in part, from the acceptance of the conceptual model of CKD as a vascular risk factor and the introduction of a standard definition and classification of CKD. In this article, we look at the impact of CKD, its close association with cardiovascular disease and how to optimise its detection and management in primary care today.
There are several blood tests available to measure blood glucose levels. Some require the patient to fast while others do not. Understanding and interpreting the results accurately are essential in optimising the management of our patients with diabetes. This article looks specifically at the HbA1c test and its significance. We define what it is and when we should carry out this test, as well as helping you to understand what the results mean and the targets we are aiming for.
Do you see patients with diabetes? Do you advise them about their diet? If so, you have an incredibly important role in developing patients' self-confidence and empowering them to be able to make healthier choices. In this article we look at how to advise patients newly diagnosed with diabetes about diet. A patient-centred approach is vital, with advice offered in a supportive, non-judgmental and non-didactic manner.
The use of language is obviously very important in effective communication, and gives important clues as to how people make sense of the world around them, and how they understand their experiences, as we saw in an introduction to neurolinguistic programming (NLP) in the last issue of BJPCN. In this article, we will look at how to use effective body language and non-verbal communication to its fullest extent in the clinic setting.