Volume 3, Number 1, January-February 2006

POPULAR
TOPICBACK TO BASICSHow Oral Glycaemic Drugs Work

DIABETES MANAGEMENTPreventing Retinopathy with Regular Screening and Effective Treatment
Valerie Wilson

Diabetes is the leading cause of blindness in the UK in people of working age. Diabetic retinopathy occurs when blood vessels in the retina become blocked, leaky, or grow haphazardly. There are usually no obvious symptoms, making the condition difficult to detect until it is well advanced. However, irreparable damage has been done by this time. This article outlines the importance of screening for early detection of retinopathy, and reviews the targets set in the National Service Framework (NSF) for Diabetes Priorities document (2003) regarding annual retinal screening tests.

DISEASE FOCUSDiabetes in Pregnancy: Future CVD Patients in Waiting?
Susan Mayor

Gestational diabetes – glucose intolerance occurring during pregnancy – is relatively common, affecting around four in every hundred pregnancies. A lot of research has linked low birth weight in babies born to mothers with diabetes to increased risk of vascular disease in later adult life. But much less attention has been focused on the mother’s subsequent health risks after having gestational diabetes. In this article, we review the increased risk of diabetes and vascular disease in later life in women suffering gestational diabetes and how to improve follow-up and prevention.

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TOPICEDITORIALFasten your seat belts: primary care jets off in new directions in 2006
Jan Procter-King

FOOD FOR THOUGHTFacing up to the Challenge of Childhood Obesity
Angie Jefferson

In a recent report on childhood obesity, the British Medical Association described the significant increase in levels of childhood obesity as a ‘cause for great concern’ and stated that healthcare professionals have a pivotal role to play in tackling this epidemic. It is estimated that there are now approximately 1 million obese children under the age of 16 in the UK and numbers are increasing annually. In this article, we review the impact of this growing epidemic, the underlying causes and how healthcare professionals can help.

EVIDENCE IN PRACTICEEvidence in Practice

There are just not enough hours in the day to read all the research journals, even if you wanted to. This section of the BJPCN – Evidence in Practice – will keep you on top of relevant research without having to spend hours in the library. Each journal review gives you a bite-size summary of new research, pulling out key points for primary care and recommending the action that you might consider taking.

POINTS MEAN PRIZESMaking Sense of Practice-Based Commissioning
Dr Stewart Findlay

Practice-based commissioning – in which practices commission care directly – will be universal by December 2006. This means that it is no longer an option for practices to commission the care they need for their patients. We must either get involved and take control of this opportunity or allow someone else to do it for us. This may be our last chance to remain independent and to manage our practices rather than being managed by others. In this article, we look at what practice commissioning will involve and how it will affect practices and PCTs.

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TOPICMONITORINGGlucose Monitoring in the Surgery – Which Test?
Sandra Waddingham

There are several blood tests that can be used to measure blood sugar levels, including random blood sugar, fasting blood sugar, glycosylated haemoglobin (HbA1C) and the glucose tolerance test (GTT). This article provides a ‘whistle-stop’ tour updating you on what information each of these tests provides, what test to use when and how to explain the procedures and results to your patients.

PREVENTION IN PRACTICEImplantable Cardioverter Defibrillators (ICDs)
Jenny Tagney

Implantable Cardioverter Defibrillators (ICDs) have – quite literally – fired a major revolution in the management of patients at high risk for potentially life-threatening arrhythmias. More sophisticated than pacemakers, ICDs monitor the heart constantly, but only initiate an electrical signal when they detect an incorrect heart rhythm. ICDs can function as pacemakers for slow heart rates, but may also deliver high-energy electrical therapy for fast heart rates. In this article, we review how ICDs work, how they are used and what care we need to provide for patients who have had these devices implanted.

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TOPICTHERAPEUTICS REVIEWAspirin in Cardiovascular Disease: the Pros and Cons
Professor Mike Kirby

Aspirin is the most widely used long-term antiplatelet therapy, achieving benefits in patients with a range of cardiovascular conditions by blocking one of the blood clotting pathways. It is cheap and relatively safe, despite the possible risks of gastric irritation or bleeding. In this article, we explore what we know about aspirin, together with its pros and cons in patients with cardiovascular disease.