Pelvic organ prolapse is common, affecting about one third of women during their lives. Most women are asymptomatic, but prolapse can be serious enough to need referral for surgery. The good news is that vaginal ring pessaries can improve prolapse symptoms and restore quality of life for most women seeking help from their GP or practice nurse.
Emergency contraception: the right choice at the right time
Until recently, there were two options for emergency contraception after unprotected sex or contraceptive failure: an oral progestogen-only tablet, and the copper-containing intrauterine device. These have now been joined by a new oral method, and this article reviews the three options in light of changing guidance on emergency contraception.
Editorial
For anyone working in the NHS, it has been a tumultuous few months. We were all gearing up to the establishment of GP consortia by 2013. Now the pace of change has slowed following the Government’s acceptance of the NHS Future Forum’s recommendations. This gives us all time to pause and remember that meeting the needs of our patients should be our first priority, and that this depends critically on the knowledge and skills of all NHS professionals.
Dealing with sexual assault in primary care
Sexual assault is common. All sections of society are affected, and victims may be men, women or children. Patients attending primary care may have no intention of reporting their assault to the police. But a trusted GP or practice nurse can ensure that victims receive appropriate specialist care through local Sexual Assault Referral Centres (SARCs).
Cervical screening: time for HPV testing
The NHS Cervical Screening Programme is universally lauded as a success story, preventing an estimated 2,000 deaths a year from cervical cancer in the UK. The programme continues to be refined in light of new evidence, and the latest development is the introduction of human papilloma virus (HPV) testing alongside cytology.
Stratifying stroke risk to guide treatment in patients with non-valvular atrial fibrillation
Antiplatelet (usually aspirin) and anticoagulant (usually warfarin) treatments are available to reduce the risk of stroke in patients with atrial fibrillation (AF) but both have potentially harmful adverse effects and warfarin can be time-consuming and expensive to monitor. Guidance exists for choosing between treatments but is often insufficiently detailed to support an informed choice about the risk and benefits. Prescribers and patients are often left with a choice between aspirin or warfarin, and aspirin – which is perceived to be safer and easy to use – is often chosen. This article explores the evidence for aspirin and warfarin in preventing stroke in patients with AF, and describes how we should change the way that decisions about treatment are made.
Drug treatment for atrial fibrillation
Irrespective of whether the atrial fibrillation is constant or occurs in paroxysms, that is, it is intermittent, the decision to administer antiplatelet drugs or anticoagulants should depend on the patient’s cumulative risk factors. These risk factors include age and previous medical history.
Looking to the future for the management of AF and prevention of stroke
Atrial fibrillation (AF) is becoming an epidemic, affecting 1% to 2% of the population in the developed world. Looking to the future, the prevalence of AF will grow dramatically in the coming decades as the elderly population increases. The growing numbers underline the need to improve the detection of patients with AF and measures for reducing their risk of stroke.
It takes a minute: check your patient’s pulse to see if they are in atrial fibrillation
The prevalence of atrial fibrillation (AF) is increasing with the ageing population. It is well worth detecting and treating as it carries a significant risk of debilitating disease, including stroke and heart failure. This article explains some of the health risks and describes simple actions that can play an important part in both the prevention and management of AF and its consequences.
Why does atrial fibrillation increase the risk of stroke?
Each year there are 150,000 strokes in the UK. Nearly one in five (18%) of the people presenting with a stroke are in atrial fibrillation (AF) at the time of presentation, and one in six strokes are directly attributable to AF. The risk of stroke in AF is reduced by two-thirds with oral anticoagulation, while antiplatelet therapy reduces stroke by one-fifth. The reduction with antiplatelet therapy is broadly consistent with the stroke reduction seen with this therapy in patients with vascular disease or risk factors, and, given that AF largely coexists with vascular disease, the effect of antiplatelet therapy would probably reflect this. The risk of stroke is similar with paroxysmal or permanent AF, in the presence of associated risk factors.
Three simple steps to reduce strokes associated with atrial fibrillation
Stroke is devastating – for the person affected, their family and the NHS. Figures in the recent NICE guideline on stroke show that around 110,000 people have a first or recurrent stroke each year in England, and a further 20,000 have a transient ischaemic attack (TIA).
Editorial
The government’s new public health strategy, Healthy Lives, Healthy People, aims to transform public health and – perhaps for the first time – to create a ‘wellness’ service to meet today’s health challenges. We may have our reservations about the NHS reforms, but improving public health is something we can all sign up to. So this issue of BJPCN focuses on one of today’s key public health challenges – obesity.
