Volume 5, Number 6, November-December 2008

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TOPICBACK TO BASICSBack to Basics: detecting and managing chronic kidney disease

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TOPICDIABETES MANAGEMENTHow to prevent and manage lipohypertrophy at injection sites
Sandra Waddingham

Lipohypertrophy is surprisingly common in people using insulin to control their diabetes. As more and more people with diabetes are managed in primary care, practice nurses take on a greater role in the management and education of these patients. This article considers what lipohypertrophy is, how it can be prevented and how it should be managed once it has been identified.

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TOPICDID YOU KNOW?It takes a minute: check your patient's pulse to see if they are in atrial fibrillation
John Campbell, Andrew Jackson

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.

DISEASE FOCUSTransient ischaemic attack: the 'funny do' that is no joke
Gillian Richardson

How do you recognise a transient ischaemic attack (TIA) and how does this differ from a full stroke? In this article, we explore the ABCD2 score, which can be used to identify high- and low-risk TIAs, and the best course of action if a TIA is suspected. A TIA is very often the herald of a more serious and permanent stroke, underlining why it should be acted on as a matter of urgency, and there is an update on the current guidance from NICE and the Royal College of Physicians.

EDITORIALEditorial
Jan Procter-King

The menopause has moved on from simply being a source of euphemisms for hot flushes as ‘power surges’ or ‘tropical moments’ to being recognised as an important stage in a woman’s life. It also has particular significance in CVD risk, which we address head-on in this issue of BJPCN.

NEWSNews from Education for Health

FOOD FOR THOUGHTDietary fibre - more than just roughage
Angie Jefferson

Dietary fibre is a frequently neglected nutrient, with eight out of ten UK adults eating less than is needed for good health. Most people think of fibre simply as roughage or bran and know that it helps with constipation and bowel disorders, but fibre is far more than this, with a wide range of health benefits. Evidence indicates that eating a fibre-rich diet will not only improve digestive health, but also aid weight loss, help to reduce cholesterol levels, and reduce the risk of certain cancers (including bowel and breast cancer) and type 2 diabetes. It will also boost intake of vitamins, minerals and antioxidants. This review explores the major role of fibre in health and wellbeing and gives practical tips for dietary advice.

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 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 PRACTICELooking through the window of cardiovascular opportunity at the menopause
Julie Ayres

Most women think they are at greatest risk of dying from cancer, especially breast cancer, but in fact, women are nine times more likely to die from cardiovascular disease (CVD) than from breast cancer. The menopause has particular significance in CVD risk. In this article we look at what happens to cardiovascular risk at the menopause and opportunities for CVD prevention.

THERAPEUTICS REVIEWTredaptive: a new option in lipid management
Mike Kirby

Blood cholesterol levels play an important role in the development of atherosclerosis and cardiovascular disease (CVD), and the incidence of CVD is closely related to the concentration of the specific lipoproteins in the blood. In this article, we review the role of different lipoproteins and the mechanism of action and potential role of a new agent for lipid modification – Tredaptive.

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TOPICPATIENT INFORMATIONStarting on a statin for primary prevention

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TOPICHANDS ONDiagnosing hypertension: getting the numbers right
Bev Cox

Hypertension is a silent, malevolent factor in both cardiovascular and renal disease. Raised blood pressure (BP) rarely causes any symptoms – in fact the presenting symptom of hypertension is too often the heart attack or stroke that is the end result. Diagnosis of prolonged abnormal blood pressure is therefore key in the prevention of a range of long-term conditions. In this article, we will examine the importance of measuring blood pressure correctly before making the diagnosis of hypertension. We will also look at the different levels of blood pressure that constitute a diagnosis of hypertension according to the variety of guidelines that exist.