Volume 1, Number 4, January 2005

POPULAR
TOPICBACK TO BASICSA BJPCN Guide – Making sense of ECGs

POPULAR
TOPICDIABETES MANAGEMENTProtecting renal function in people with diabetes
Sandra Waddingham

Renal disease is common and is increasing in prevalence as the main risk factor for impaired kidney function – diabetes – affects more people. Approximately 30% of patients with type 2 diabetes develop some degree of nephropathy, with some ethnic groups at even higher risk. Diabetes is now the largest single cause of end-stage renal disease in the UK, accounting for 30–40% of all cases. The very early stages are asymptomatic and the disease process develops slowly over 15–20 years, so early screening and prevention strategies are paramount in reducing the burden of renal failure. Primary care nurses are well placed to play a pivotal role in this process.

DISEASE FOCUSDisease Focus on... Sleep Apnoea
Professor Mike Kirby

Sleep apnoea is far more than just snoring associated with brief periods of suspended breathing while asleep. It is an important risk factor for cardiovascular disease and diabetes, so it is well worth asking patients whether they suffer breathing problems during the night and then following up those who do. More than one-third of people with sleep apnoea have hypertension, so measuring blood pressure is important in assessing risk factors and then establishing appropriate preventive treatment.

EDITORIALNew year’s resolutions: take one small step at a time
Jan Procter-King

It’s that time of year again. New Year – time for resolutions, many of which are associated with health. Personal New Year’s resolutions are often about losing weight, getting fit or eating more healthily. All good news for cardiovascular health, the focus of BJPCN. But, as primary care nurses, we could have broader new year’s resolutions, affecting our clinical practice and efforts to improve the health of our patients. Persuading anyone – including ourselves – to change behaviour in an effort to improve health can be challenging at the best of times. The answer seems to be to just take one small step at a time – one that you know you can repeat with ease. Don't attempt a revolution. In this issue, we offer a range of ideas that you could adopt as ‘new year resolutions’ for your practice – or even yourself!

EVIDENCE IN PRACTICEThere 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-sized summary of new research, pulling out key points for primary care and recommending the action that you might consider taking.
Dr Chris Harris

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-sized summary of new research, pulling out key points for primary care and recommending the action that you might consider taking.

POPULAR
TOPICHAVE YOU HEARD?Flora Fit Street
Welcome to another unique service helping your practice achieve QOF targets
Therapies for diabetes
New European diabetes nursing journal
BHF gets kids to get fit
Salt – facts for a healthy heart

POPULAR
TOPICMONITORINGGetting it right – how to measure BP in the surgery

It’s something that we do so often, but are we always doing it the best way? Check out how to measure blood pressure (BP) correctly, with latest advice from the National Institute for Clinical Excellence and the British Hypertension Society.

POPULAR
TOPICPATIENT COMMUNICATIONMaintaining motivation: the long haul of weight loss
Marney Quinn

There is no doubt about it, achieving and maintaining weight loss long term is a great challenge. Primary care nurses have a significant role in motivating patients to adopt a healthy lifestyle and to persevere with weight management programmes. In the last issue of BJPCN we looked at how to raise the tricky subject of obesity with patients. This time, we continue the issue by exploring how practice nurses ensure a positive working relationship with their patients with weight problems and encourage them as they tackle the long-term issue of obesity.

PRACTICE TOOLSDisposing of used syringes and other sharp clinical waste
National Diabetes Support Team

More and more is being expected of practices in improving the management of diabetes – with initiatives such as the National Service Framework (NSF) for Diabetes and NICE guidance setting increasingly ambitious targets. The National Diabetes Support Team (NDST) has been set up to help support local services throughout the NHS and in meeting these challenges. In this issue, they share latest advice for practices and patients on disposing of used syringes and other sharps.

PREVENTION IN PRACTICEStop the clot: achieving effective anticoagulation in patients with heart disease
David Fitzmaurice

Thromboembolism is a common complication of heart disease – particularly in patients with atrial fibrillation (AF). Decisions to prescribe an anticoagulant are based on assessment of an individual patient’s risk of clotting and the side-effects of treatment. With growing numbers of patients with heart disease, the number of patients on anticoagulants is increasing and there is a shift to primary care-based anticoagulation clinics. Practice nurses have a central role in educating patients about anticoagulation therapy and in monitoring their ongoing care.

POPULAR
TOPICPREVENTION IN PRACTICEWhat patients think about long-term anticoagulant therapy
Eve Knight

Effective long-term anticoagulation requires a good working partnership between patients and the healthcare team. A key part of this is that patients understand how their treatment works, why it has been given and how to take it correctly. AntiCoagulation Europe, a patient organisation for people on anticoagulants, recently carried out a survey of 711 patients with atrial fibrillation (AF) from seven European countries (France, Germany, Italy, Norway, Spain, Sweden and the UK) being treated with a vitamin K antagonist (VKA) such as warfarin. The it’s about time survey was designed to explore patients’ insights into their treatment.
The results show that many patients have gaps in their understanding about anticoagulation therapy and emphasise the need for ongoing patient education and the development of more patient-friendly anticoagulants to improve outcomes and quality of life.

PREVENTION IN PRACTICEOptimising lipid levels: looking beyond LDL-cholesterol
Sue Lyon

Treatment with statins is undoubtedly making a major contribution to reducing high-risk patients’ chance of a heart attack or another coronary event. However, their risk remains high, since over half of patients included in statin clinical trials suffered a further coronary event within five years. There is growing evidence that we need to move beyond simply lowering low-density lipoprotein cholesterol (LDL-C) and optimise the whole lipid profile.

Q & AYour questions answered

THERAPEUTICS REVIEWBeta blockers
Dr Rubin Minhas

Beta blockers are well established drugs in the treatment of cardiovascular disease, after first being introduced 20 years ago. Today, they are used to treat patients with a range of cardiovascular conditions – hypertension, myocardial infarction, angina, heart failure and abnormal heart rhythms (arrhythmias). There is good evidence for beneficial effects with beta blockers and their use is recommended in many guidelines, including the recent British Hypertension Society guidelines. Prescribing of beta blockers in patients with heart disease is further encouraged as a 'quality marker' in the new GMS contract.