Primary angioplasty is now recognised as the best treatment for clearing a blocked coronary artery after an ST segment elevation myocardial infarction (STEMI) and increasing numbers of patients will undergo this procedure as it becomes more available. In this article, we explore what is involved in primary angioplasty, what you need to tell to your patients and how to care for them after this procedure.
Exenatide (Byetta) is the first glucagon-like peptide-1 analogue (GLP-1 analogue) to be approved for the treatment of type 2 diabetes. It is a twice-daily injection, currently prescribable only by consultants, given before breakfast and before the evening meal. The early signs are that this new and different medicine has the potential to be very exciting for both patients and healthcare professionals. Studies show a reduction in HbA1c as well as steady weight loss – every diabetic's dream! In this article, we look at how exenatide works, where it fits into current practice and the pros and cons of this new preparation.
Obesity poses a major threat to the nation's health and a national strategy is required to stem the rising prevalence, decrease the morbidity and mortality from associated conditions, and reduce pressure on the National Health Service. Primary healthcare staff will be at the centre of any such approach. Practice nurse-led lifestyle clinics have demonstrated that clinically beneficial weight loss can be achieved with a structured approach to weight management. In this article, we explore the impact of obesity and best practice strategies to help patients lose weight.
As people get older, their use of medications tends to rise and elderly patients often take a variety of medicines for an increasing number of health problems. Four in five people over the age of 75 years take at least one prescribed medication, while 36% are taking four or more, according to the 1998 Health Survey for England. How can we help our older patients to take their medicines, optimising convenience and minimising risks of non-compliance and sideeffects?
Atrial fibrillation (AF) is a condition that we are seeing more and more in general practice, with the increasingly ageing population. It is an important risk factor for stroke – particularly in older people – making it a good candidate for primary care teams to target in efforts to prevent cardiovascular disease. In this article, we explore how to diagnose and treat, using a case study to guide us through the key issues.
Higher cardiac mortality in the winter has long been recognised. It may be due to colder temperatures, which have been associated with depression of heart rate variability and increases in vascular resistance, coronary vasospasm, blood pressure and haemostasis. The peak in cardiac mortality around Christmas and New Year is likely to be compounded by factors that accompany the holiday season: overindulgence in food, salt and alcohol, emotional stress or depression, exposure to particulates from fireplaces, holiday-induced delays in seeking medical attention and reduced staffing of healthcare facilities. How can we help our patients to reduce their risk?
Sitagliptin (trade name Januvia) is the first in a new class of drugs for diabetes – the dipeptidyl peptidase-4 (DPP-4) inhibitors. This new, oral hypoglycaemic agent has recently been approved for the treatment of type 2 diabetes. It is available on prescription and can be prescribed in primary care. Principal advantages include lack of weight gain and hypoglycaemia, which should make sitagliptin very popular with patients. This article looks at what a DPP-4 inhibitor is and how it works to lower blood glucose, as well as where this class of drug fits into current practice.