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
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.
Editorial
As practice nurses, our day at the surgery ends well when everything has gone smoothly and patients and colleagues have gone home happy. But we often feel the greatest sense of achievement when we have had to go beyond our usual routine to try a new approach to a problem, or do something that we never thought we could do.
Recognising the risk of familial hypercholesterolaemia
Familial hypercholesterolaemia (FH)—an inherited genetic defect that causes high blood cholesterol—often goes unrecognised. It is therefore under-diagnosed and poorly managed. This can have devastating repercussions for affected families, since premature deaths from heart disease can occur in people in their 40s or even younger. This article looks at the causes of FH, how to recognise those at risk and how to implement National Institute for Health and Clinical Excellence (NICE) guidance in practice.
Back to Basics: Oral blood glucose lowering therapies
Time to start insulin in general practice
General practices are under increasing pressure to initiate insulin in type 2 diabetes, as it would be more efficient for the health service and more convenient for most patients. There are many different approaches to starting insulin, but it is essential for practice nurses to work closely with patients and progress slowly to ensure successful and safe outcomes.
Starting insulin treatment for type 2 diabetes
Chronic kidney disease: the no tears review
Many drugs are cleared from the body by the kidneys, so careful medicines management is especially important in people with chronic kidney disease (CKD). This article explains how to ensure CKD patients receive recommended therapies designed to protect their kidneys and reduce their risk of a heart attack or stroke.
On the beat: Controlling heart rate in angina and heart failure
Controlling heart rate is a key element of good care of patients with angina or heart failure. In this article we explore the benefit of effective heart rate control to reduce hospitalisation and alleviate symptoms. Measuring heart rate is simple, and can provide valuable benefits for many patients.
