Although many members of the medical profession might agree that theirchosen discipline often leads to periods of weariness, frustration or anxiety, thegreat majority of individuals in active practice would find it difficult to single outa dull day in their way of life.” (David Seegal, Yale Scientific Magazine 1962;36:31)
Keeping on track: streamlining diabetes management in older patients
Key issues in the management of older patients with diabetes involve both clinical skills and apatient-oriented approach. Ageing and co-morbidity may make management challenging, andclinicians need to be alert to factors such as impaired cognitive function, depression andincreased susceptibility to hypoglycaemia.
Optimising risk factor modification and prevention of stroke
Prevention of stroke is a key component of the overall management of stroke. Primordial prevention strategies include avoidance of tobacco use, maintenance of an adequate level of physical exercise and optimal diet and weight, and avoidance of heavy alcohol intake. Several medical risk factors have been demonstrated clearly, and intervention to optimise these risk factors for primary prevention (of first stroke) and secondary prevention (of stroke in those known to have cerebrovascular disease) has a robust evidence base.
The EPCCS and the implementation of CVD prevention in general practice
The European Primary Care Cardiovascular Society (EPCCS) exists to inform, support and interact with general practitioners (GPs) across Europe in relation to cardiovascular disease, including stroke and diabetes. The EPCCS provides an interactive and expanding website at www.epccs.eu with news, comments, information, meeting reports and slide presentations.
Insulin in type 2 diabetes – a growing role for primary care
Today, many people with type 2 diabetes who need insulin have their insulin initiated in primary care. Here we discuss NICE recommendations for initiation and management of insulin, and the different types of insulin and delivery systems.
A local strategy to improve outcomes for TIA and stroke
We describe here a project that sets out to reduce the risk of stroke in patients suspected of having a transient ischaemic attack.
Vitamin D and cardiovascular health
Vitamin D deficiency is a prevalent and important health issue that warrants vigilant systematic screening and appropriate treatment and follow-up on the part of physicians, especially those in the primary care and cardiovascular fields. Although vitamin D deficiency has traditionally been associated primarily with bone disease, it is now clear that this is a multi-organ system disease. Epidemiological studies consistently show strong associations between vitamin D deficiency and bone disease, cancer and diabetes. Additionally, epidemiological evidence links vitamin D deficiency with cardiovascular risk factors, cardiovascular disease and mortality. Conclusive evidence to show that vitamin D supplementation improves cardiovascular prognosis is currently lacking, although randomised trials are under way to address this issue. In this article we review the sources and metabolism of vitamin D, the epidemiology of vitamin D deficiency, and the available evidence linking vitamin D deficiency to cardiovascular disease; and we suggest an approach to systematic screening and to treatment of vitamin D deficiency.
Understanding the impact of statin titration: a modelling approach
Introduction: Clinical guidelines specifying target cholesterol levels may require dose titration strategies for patients who do not reach target. We describe a model that simulates cholesterol and cardiovascular risk reductions for different populations, therapies, titration steps and targets.
Looking back, looking forward: reflecting on the winter season and the demise of the PCCS
The message regarding eating less has come across loud and clear this year, but there has been plenty to worry about over the last twelve months. The demise of the Primary Care Cardiovascular Society (PCCS) has been on my mind. I was saddened to attend an Extraordinary General Meeting in January 2012, when it was decided to wind up the Society with honour due to declining funds and concern that this situation was likely to deteriorate for the foreseeable future. The closure of the PCCS is a great blow to all of us interested in promoting and improving the prevention and management of cardiovascular disease in our communities.
EUROPEAN SOCIETY OF CARDIOLOGY CONGRESS 2010
Keeping on track for good concordance with CVD and diabetes drugs
What is important when a nurse and patient are together in a consultation? Most of us have had consultations where the discussion did not appear to achieve anything, while, on other occasions, both parties seemed to be working well together. This article looks at how to share the process of planning treatment with a patient to improve health outcomes; it examines what concordance is, and how to achieve it, looking at how this might work out in practice.
Managing patients with recent onset chest pain: key steps
Chest pain and discomfort are common symptoms that account for 1% of visits to primary care, 5% of visits to accident and emergency departments and 25% of emergency hospital admissions. Coronary artery disease (CAD) is one of many causes of chest pain and is the commonest cause of death in the UK. However, there are treatments available that can improve symptoms and prolong life, making prompt assessment and diagnosis essential. The National Institute for Health and Clinical Excellence (NICE) has recently published a new guideline on the assessment and investigation of patients presenting with acute chest pain suggestive of acute coronary syndrome (ACS) and stable chest pain suggestive of angina. It includes recommendations that will mean some changes to the way these patients are managed in practice. This article looks at how we can put these changes into action.
