Volume 5, Number 4, July-August 2008

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TOPICBACK TO BASICSWhat goes wrong in atrial fibrillation?

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TOPICCHANGING BEHAVIOURUsing neurolinguistic programming to help patients achieve their goals
Christine Mclean

How can you help patients to achieve their goals when trying to improve their health? In this article, we explore the neurolinguistic programming (NLP) technique of defining “keys to an achievable outcome”. The theory is that the more specific you are about the goal you are aiming for, the more achievable it becomes. This follows two articles in previous issues where we examined how to develop rapport with patients using linguistics and body language effectively (see www.bjpcn.com if you missed them).

DIABETES MANAGEMENTLooking after women with diabetes during pregnancy
Sandra Waddingham

The care of pre-existing diabetes during pregnancy is complex and the remit of secondary care, but much can be done by primary care staff to ensure that pregnant women and their babies are safely on the right track by the time pregnancy is confirmed. In this article, we explore how to provide women with pre-existing diabetes with detailed and accurate preconceptual advice. Work needs to begin before contraception is discontinued to significantly reduce the risks for both mother and baby. In women with gestational diabetes, practice nurses can also be proactive postnatally, preventing progression to type 2 diabetes.

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TOPICDISEASE FOCUSMaking sense of type 1 diabetes in primary care
Sandra Waddingham

Primary care has traditionally managed people with type 2 diabetes, and people with type 1 diabetes have largely been the responsibility of secondary care. However, as blood glucose targets have become tighter and growing numbers of people with type 2 diabetes have started to require insulin, many in primary care have gradually taken on insulin management. As primary care professionals become more confident in the management of patients on insulin, many practices will be keen to take on the challenge of type 1 patients. This article looks at how type 1 differs from type 2 diabetes, which type 1 patients might be managed appropriately in primary care, and recaps on insulin regimens and dose adjustment.

EDITORIALEditorial
Jan Procter-King

Happy 60th birthday to the NHS! The service has transformed the health of people in this country over its 60 years, and a significant part of this has been in cardiovascular disease and diabetes, the focus of BJPCN. We hope this issue will provide a ‘party bag’ of useful goodies that you can dip into to help in your everyday practice over the next sixty years!

NEWSNews from Education for Health

FOOD FOR THOUGHTWholegrains: sorting out the wheat from the chaff
Sue Baic

The seeds of cultivated cereal crops, or grains as they are also known, have been used as a staple of man’s diet for thousands of years. Indeed the cultivation of rye, the first cereal crop from around 10,000 BC, is credited with enabling our hunter-gatherer ancestors to form more settled, complex civilisations. Throughout most of our history we’ve eaten these grains “whole” in the form of unpolished rice or wholewheat flour, for example. It’s only in last 120 years or so that more refined milling techniques have enabled the white or refined forms of these cereal crops to become the preferred choice in much of western society. What impact does this change have for our health?

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TOPICEVIDENCE 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 BJPCN – Evidence in Practice – will keep you on top of relevant research without having to spend hours in the library. Each 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.

HAVE YOU HEARD?Have you heard?

PREVENTION IN PRACTICEFamilial hypercholesterolaemia: caring for the one in 500 patients affected
Jonathan Morrell

Familial hypercholesterolaemia (FH) is the commonest genetic disorder in people of European and Japanese descent, affecting about 1 in 500 people. It is characterised by high levels of total and LDL cholesterol and is the most important clinical syndrome leading to premature coronary heart disease (CHD). Despite huge advances in unravelling its complex pathophysiology and the effectiveness of modern treatments, awareness of the syndrome and its consequences remains low and affected individuals are still overlooked and denied the potential benefits of treatment.

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TOPICQUALITY MATTERSLipid lowering as part of secondary prevention of CVD: doing it the nice way
Jan Procter-King

All patients with cardiovascular disease (CVD) should be offered drug treatment to reduce their cholesterol levels without waiting for the management of modifiable risk factors, recommends the latest guidance on lipid modification from the National Institute for Health and Clinical Excellence (NICE). The much-anticipated guideline finally puts to bed the ‘5 and 3’ or ‘4 and 2’ debate over cholesterol levels for primary and secondary prevention. In this article, we review what the guidance says about lipid lowering in secondary prevention.

THERAPEUTICS REVIEWWarfarin for atrial fibrillation: ‘faff’ or lifesaver?
Campbell Cowan, Shona Holding, Keith Tyndall, Adele Graham

Improving the management and prevention of stroke is a priority for the NHS. Atrial fibrillation (AF) is widely recognised to be a major cause of stroke. Moreover, it is a preventable cause in that the increased risk of stroke associated with AF can be markedly reduced by anticoagulation with warfarin. Yet a substantial number of cases of AF remain undetected and untreated. Of more concern, even after identification of AF, many individuals at high risk of stroke do not receive warfarin. This article reviews the evidence on the importance of AF as a cause of stroke and assesses the benefits of anticoagulation and our reluctance to anticoagulate. Finally, it explores ways of improving on current practice, to increase the proportion of patients with AF receiving anticoagulants.

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TOPICKEEP AND COPYStarting on a sulphonylurea

HANDS ONHands on peripheral arterial disease
Bev Cox

Peripheral arterial disease (PAD), also known as peripheral vascular disease (PVD), is a vascular condition which affects the legs. It is caused by atherosclerosis – narrowing and hardening of the arteries – and has previously been described as being similar to angina in the legs. Sufferers get cramping pains in their legs when they walk, which is relieved by rest. This is similar to the chest pain that occurs in people with coronary heart disease (CHD). The similarities between CHD and PAD do not end there: the causes and treatments also overlap. In this article, we explore how two patients presented with symptoms suggestive of PAD and how they were treated.