Venous thromboembolism (VTE), comprising deep vein thrombosis (DVT) and pulmonary embolism (PE), is a major public health problem affecting around 100 per 100,000 population per year and causing thousands of deaths annually. Large population-based studies have shown that factors associated with hospitalisation account for half of the attributable risk of VTE.
When to use aspirin in CVD prevention: acting on the latest evidence
Standing up, sitting or lying down: what do these BP readings mean?
Maintaining a healthy blood pressure (BP) is important in preventing cardiovascular events such as heart attack and stroke, and measuring BP is a key step in cardiovascular risk assessment. However, it is not always measured correctly. Readings should be taken from both arms and the higher reading of the two, if there is a difference, should be used and a record should be kept of the preferred arm for future readings. But what about the patient’s position? Does a lying and standing measurement need to be done in all patients? What is an ‘acceptable’ difference? And does it matter?
Making sense of HDL cholesterol in cardiovascular risk
Lowering LDL cholesterol (LDL-C) with statins for the prevention of cardiovascular disease (CVD) has rightly become a core activity for primary care health professionals. However, despite effective lowering of LDL-C, many patients still suffer cardiovascular events. Experts have called this ‘the residual risk’ and have speculated whether further cardiovascular events can be prevented by attention to other lipoprotein fractions, particularly HDL cholesterol (HDL-C).
Helping patients with diabetes to win the battle to control their weight
Many people with type 2 diabetes are overweight or obese at diagnosis and continue to struggle to control their weight. This article looks at why people with diabetes find weight control more of a challenge than the rest of us and how practice nurses can help patients to remain positive, particularly when starting insulin to optimise blood glucose control.
What factors influence what we choose to eat and how can we improve choices?
Obesity is, quite literally, the big health problem of the 21st century, with rapidly increasing rates in both adults and children. In this article we explore why obesity is such a challenge and the role of primary healthcare professionals in addressing the problem. We try to unravel the wide range of factors that cause obesity before focusing on why people eat what they do and how we can help patients to review their eating habits, introduce changes to eat more healthily and then sustain those changes.
Back to Basics: How to use a large-volume spacer
Thunderstorm Asthma
On 23 June 2005, the Met Office issued a warning that severe thunderstorms were likely
to hit the South East of England in the next 24 hours. On the evening of Friday 24 June,
primary care out-of-hours services and hospital accident and emergency departments
in Northwest London were inundated by patients attending with acute asthma. The
scale of these attendances – eight times more patients than usual in one hospital – meant that
departments had to call in additional staff and some ran out of emergency supplies of
bronchodilators, nebulisers and oral steroids for treating asthma. In this article, we will explain
the background and some of the theories related to this type of epidemic of acute asthma –
Thunderstorm Asthma.
Scoring top marks for smoking cessation
This year, as 1 July and ‘no smoking in public places’ approaches in England, many more
patients will want help to stop smoking. Practices in Scotland and Wales are already
facing this challenge. How do we optimise the smoking cessation advice we offer at the
same time as juggling the many other responsibilities we have? In this article, we look at
how to score top marks for Quality and Outcomes Framework (QOF) indicators on smoking
cessation – recording information and offering advice that will help patients to quit as well as
gaining extra payments for our practices.
Making Sense of Drug Allergy: What Goes Wrong and Why
Allergic or other immunological mechanisms are thought to account for 6-20% of
all adverse drug reactions, but in most cases the mechanism is unclear. This
article provides an in-depth review of drug allergy – adverse drug reactions with
a known immunological mechanism or with clinical features that mimic an
immunological reaction.
Editorial: Spring
Was it me? Did I blink and miss the spring? There I was, trying to plan my
early initiation of inhaled steroids and nasal sprays to ward off seasonal
exacerbations of allergic rhinitis and asthma but spring just doesn’t seem
to have sprung this year! It made me wonder whether the wet weather
had an influence on hay fever levels.
Anticholinergics: How do they Work?
Anticholinergic drugs are bronchodilators that act by blocking acetylcholine, the
neurotransmitter for the parasympathetic nervous system. By blocking parasympathetic
stimulation, anticholinergics reduce cholinergic tone, therefore producing
bronchodilation. In this article we review when and how these drugs should be used.
What are their potential benefits and what should we tell patients who need them?
