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?
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.
The consistency and magnitude of cholesterol lowering achieved following the introduction of statins has resulted in less importance being given to long-term diet-based interventions over the past few years. Nevertheless, lifestyle changes are, and will remain, the preferred option before resorting to long-term drug therapy. They are also essential in people below the cut-off cholesterol level for drug treatment or where side-effects limit drug use. This article reviews the portfolio diet and its role in cholesterol management.
The aim of cardiac rehabilitation is to help people who have had a cardiac event recover and resume as full a life as possible and help reduce the risk of further cardiac problems. The 'cardiac hope and confidence programme' is a good way of describing the rehabilitation process as many patients tell us that this is what they gain most from the programme. We review what happens in phase III cardiac rehabilitation and what it can achieve in practice.
With increasing awareness about preventable acquired infections along with everincreasing patient knowledge, it is essential that all healthcare staff understand the principles underpinning infection control. In particular, they need to be clear about hand hygiene and the appropriate use of gloves if they and their patients are to remain safe from the risk of transmission of microorganisms and the infections they cause. We review when gloves are needed and when they are not.
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.
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.