Volume 3, Number 4, July-August 2006

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TOPICBACK TO BASICSManaging Hypertension: Updated NICE Guideline

DISEASE FOCUSHeart Murmurs – When Are They Significant?
Professor Mike Kirby

Heart murmurs – abnormal sounds heard through the stethoscope – are caused by turbulent blood flow in the heart or blood vessels. They can be associated with a range of conditions, including valve defects, high blood pressure and heart failure in adults and congenital heart defects in children. Patients should be investigated carefully to identify the underlying cause, which will determine treatment and prognosis. Some pathological murmurs require no treatment. If they are severe, however, surgery may be needed to correct the causative defect. Drug treatments may be indicated for some murmurs.

EDITORIALEditorial
Jan Procter-King

I am keeping my fingers crossed as I write this that you are all having to apply sun protection factor 30 as a result of a glorious summer and that you are enjoying reading this issue of British Journal of Primary Care Nursing to the accompaniment of gently chinking ice cubes as drinks are served to you while you recline under a parasol! Well it was a nice thought!

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TOPICFOOD FOR THOUGHTFunctional Foods: More Than Just Good To Eat
Sue Baic

There has been a flurry of interest in functional foods over the past few months. Health claims range from lowering cholesterol to improving vitality. Functional foods have been popular in the Far East for many years but only arrived in the UK six years ago. They are now the most rapidly growing sector of the food industry, with estimates suggesting we currently spend around £1 million on them every day. To make informed choices, consumers and health professionals need to know the truth behind the hype. In this article we review the range of functional foods now available, take a look at the evidence for their claims and explore the pros and cons of using them.

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 PRIZESWhat is New in the QOF?
Dr Stewart Findlay

The Quality and Outcomes Framework (QOF) has been a huge success and primary care in the UK is now delivering some of the best results in the world for the management of chronic disease. The Department of Health is obviously keen to continue to drive up quality in existing domains and extend the QOF to new areas of health care, with an updated list of indicators published earlier this year. In this article we explore what has changed.

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TOPICMONITORINGScreening for Depression in the Cardiovascular Disease Clinic
Bev Cox

The revised new GMS contract recommends that we screen patients with coronary heart disease (CHD) and diabetes for depression. This is evidence-based, as we know that people with long-term conditions are at high risk of anxiety and depression; but who is going to do it, how is it done and when do we find the time? It would seem obvious to include some sort of screening process in the annual CHD or diabetes review – but is this feasible? In this article we review practical ways of screening for depression in patients with CHD and diabetes.

PREVENTION IN PRACTICEApples and Pears: Targeting Abdominal Obesity
Jane DeVille-Almond

Healthcare professionals spend a great deal of their time screening for, and treating, silent killer diseases such as diabetes, hypertension and hyperlipidaemia but often ignore the primary cause of these conditions, which is often – quite literally – staring them in the face. Obesity can be seen without the need to use any fancy gadgets – we simply need to use our eyes each time we see a patient. There are essentially two main body shapes – apples and pears – each associated with different distributions of body fat. Pearshaped people carry most of their excess fat around the hips, buttocks and thighs. Apples carry most of their excess body fat around the middle; this is known as central obesity and is much riskier for diabetes and cardiovascular disease. In this article we review why central obesity matters, how to measure it and management strategies.

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TOPICTHERAPEUTICS REVIEWThe NICE Guidance On Statins – What’s New?
Dr Sarah Jarvis

It would be easy to think that there was no more progress for statins to make. Since the publication of the landmark 4S study in the early 1990s, statins have become one of the most commonly prescribed drugs in the UK. But the recent publication of new NICE guidance on statins, and the second Joint British Societies guidance on cholesterol management for prevention of cardiovascular disease (JBS2) have changed the rules yet again. Under their recommendations, millions more patients become eligibile for statins to reduce their cholesterol.