Prevention of Diabetes
To prevent the onset of diabetes it is recommended to
maintain a low-carb diet and exercise regularly to help
reduce levels of insulin. This will help prevent diabetes
from developing by maintaining a normal blood sugar
level. It's very important for diabetes to be diagnosed
as early as possible because it will get progressively
worse if left untreated.
Overview of Diabetes
Diabetes is a lifelong condition which causes a person’s blood sugar level to become too high. There are two main types of diabetes:
Type 1 Diabetes is where the body’s immune system attacks and destroys the cells that produce insulin,
Type 2 Diabetes is where the body doesn’t produce enough insulin or the body’s cells don’t react to insulin.
Symptoms of Diabetes
Symptoms of the condition include feeling thirsty, urinating more frequently, blurred vision, weight loss.
Insulin injections are an essential part of the daily regime for many diabetics. Insulin is usually injected several times a day, and more than one type of insulin may be needed. Your doctor will tell you which type(s) of insulin to use including how much insulin to use, and how often to administer insulin.
Our Practice diabetes clinic is run by the Practice Nurse. Our Patients are invited to attend for monitoring of blood sugar, urine tests, advice on diet, eye examination, foot care, blood pressure levels and the effects of this condition on general health and social situation.
Clinical management of diabetes
To improve the quality and duration of life of people with diabetes:
- By early diagnosis of diabetes
- By the maintenance of near normal blood glucose levels
- By the reduction of risk factors such as smoking, obesity, hyperlipidemia and hypertension.
- By the early detection and treatment of complications
- To educate and empower the patient to achieve both psychological as well as physical well-being.
Recommended life style
- Normal weight for height (BMI near to 25.0)
- Diet – healthy eating. Half dietary intake should consist of carbohydrates (preferably complex) reduce sugary foods, reduce fats; (particularly saturated) reduce sugary foods, reduce fats; (particularly saturated) reduced salts, alcohol in moderation. Special “diabetic foods” are NOT recommended - replace saturated fats with mono or poly unsaturated fats
- Exercise – at least 3 half an hour walks per week, or a level of exercise that is appropriate
- Smoking – STOP
- The diet recommended for those with diabetes or those at risk of developing diabetes is the same healthy balanced diet recommended for the general population. About 1/5 of the dietary consumption should be foods rich in protein (e.g. fish, meat, - preferably white meat), eggs or cheese. 2/5 should consist of simple food (i.e. rice, pasta, potatoes, bread etc.) and the remaining 2/5 should be fresh fruit and vegetables. Carbohydrates should comprise 50-55% of dietary energy and intake and protein should comprise around 10-15% of the dietary intake.
- Maintenance of modest weight loss through diet and physical activity reduces the incidence of type 2 diabetes in high-risk people by over 40-60% over 3-4 years. Lifestyle intervention is more effective than metformin at preventing the incidence of type 2 diabetes in people at high risk.
- Exercise can improve glucose uptake by increasing insulin, sensitivity and lowering body adiposity and can result in improved glycemic control in type 2 diabetes. Taking 30 minutes of moderate exercise (mostly walking) every day in combination with adoption of a low-fat diet, can reduce the risk of developing diabetes by half. Greater frequency of activity confers greater protection from development of type 2 diabetes. Exercise has established benefits on weight-loss, lipid profiles, and blood pressure, as well as psychological benefits.
- Lipid profile will be checked annually
- Aim for Cholesterol <4 mmol/1
- Aim for LDL <2 mmol/1
- Aim for triglycerides <1.5 mmol/1
- Use statin e.g. Simvastatin, Atorvastatin, Rosuvastatin, and Add Ezetimibe if required.
- BP checked each visit
- Aim for BP <140/80 mmHg
- If micro-albuminuria present BP <135/75/ mmHg
- Medication use.
3 Monthly and 6 Monthly Checks
Every NIDDM Patient is reviewed at least 6 monthly
- Well-being and home monitoring results (same objectives etc. as for annual review)
- HbA1C, BP, Weight, Compliance, Urinalysis preformed at each visit
- Address patient needs and concerns
- Flu vaccination recommended every year
- Pneumococcal Vaccine recommended
- Update Care card and computer
- Blood Glucose management
- HbA1c checked 6 monthly; aim 48-58 mmol/mol
- Patients taught to blood test own sugar levels if appropriate (instructed by the Nurse)
- Encourage weight loss & increase physical exercise in those who are obese – refer to local exercise programme if appropriate.
Every Patient with a diagnosis of diabetics should receive an annual review.
HbA1c Standardisation for clinical healthcare professionals
What is HbA1c?
Glucose in the blood binds irreversibly to a specific part of hemoglobin in red blood cells, forming HbA1c. The higher the glucose, the higher the formation of HbA1c. HbA1c circulates for the lifespan of the red blood cell, so reflects the prevailing blood glucose levels over the proceeding 2-3 months.
Why measure it?
Serial measurements of HbA1c show how an individual’s glucose control, and thus risk of complications, changes in response to alterations in management. HbA1c should be measured every 2-6 months. Target HbA1c levels can be set for individual patients and therapy adjusted accordingly.
What are the current targets?
General targets for HbA1c of 48-58 mmol/mol should be set for an individual, taking into consideration their risk of severe hypoglycemia, cardiovascular status and co-morbidities.
It is important to identify and avoid situations where your Asthma might be triggered. This is the best way to reduce your need for medication and to prevent asthma episodes. It would help to learn what triggers your Asthma. Any time you have an Asthma episode, think about where you were and what you were doing the past day or so. Answer questions like these in a diary or on your calendar:
- Was I making a bed or vacuuming?
- Was I near an animal?
- Cigarette smoke?
- Did I have a cold or other infection?
- Was I running, playing or exercising?
- Was I upset, excited or tired?
Chronic obstructive pulmonary disease (COPD) occurs when the lungs become inflamed, damaged and narrowed. The main cause is smoking, although the condition can sometimes affect people who have never smoked. The likelihood of developing COPD increases the more you smoke and the longer you've smoked.
Overview - Asthma
Both adults and children who suffer from asthma will experience times when their breathing becomes more difficult. Some people with more severe asthma may have breathing problems on a regular basis.
Overview - COPD
Chronic obstructive pulmonary disease (COPD) is the name for a group of lung conditions that cause breathing difficulties. Such difficulties which can be encountered include:
- Emphysema – damage to the air sacs in the lungs,
- Chronic bronchitis – long-term inflammation of the airways.
The most common symptoms of asthma are:
The damage to the lungs caused by COPD is permanent, but treatment can help slow down the progression of the condition.
Treatments for Asthma / COPD include the following:
- Stop smoking – if you have COPD and you smoke, this is the most important thing you can do,
- Inhalers and medications can be prescribed to help make breathing easier,
- Pulmonary rehabilitation is a specialised programme of exercise and education,
- Surgery or a lung transplant although this is only an option for a very small number of people.
In order to improve risk factor and symptom management of Asthma, at the Practice monitoring clinic the Practice Nurse will aim to focus on improving lung function through regular review of medication and inhaler technique.
- Patients will be seen at intervals appropriate to their needs until they are controlled:
- Newly diagnosed and poorly controlled patients (as required) until stable,
- All asthmatic patients within the Practice should be seen at least once twice a year.
1st follow-up visit
- This should be within 2 weeks of diagnosis,
- Discussion of diagnosis, recent symptoms, patients understanding of condition.
- Measure Peak Flow(PF) / monitor home recordings of PF
- Check inhaler technique and correct if necessary
- Continue education about asthma, giving appropriate non-promotional literature
- Evaluate treatment and refer back to GP if necessary
- Arrange next follow-up as appropriate.
Checks should include:
- Peak Flow
- Inhaler technique
- Initial Height
- Blood Pressure
- Trigger Factors
- Night Cough – present /absent
- Last- Asthmatic cough
- Time off from school / work in last six months
- Smoking status
- Alcohol consumption
Self – Management Plan
Patients on reliever’s only beta2 agonists or Atrovent may increase inhaler to up to 20 puffs per day. If symptoms persist or inhaler effective for less than 4 hours to contact the GP to commence steroids.
Chronic obstructive pulmonary disease
Chronic obstructive pulmonary disease (COPD) can be better known as chronic bronchitis, emphysema or chronic unremitting asthma. The main symptoms associated with the condition are shortness of breath, cough and production of phlegm that may worsen at certain times of the year. COPD is a progressive disease that is largely preventable. Smoking is the main cause of COPD.
Clinical protocol - Aims and objectives
- Prevent disease progression
- Relieve symptoms
- Improve general health
- Prevent and treat complications
- Prevent and treat exacerbations
- Reduce mortality
- Smoking cessation
- Minimise side effects of treatment
Reduction of risk factors
- Smoking cessation
- Occupational exposure
- Indoor and outdoor pollution
- Management Goals
- Determine disease severity
- Implement stepwise plan for therapy
- Treat accordingly to nationally agreed guidelines
- Patient education
Promote effective inhaled therapy
- People with stable COPD who remain breathless or have exacerbations despite use of short-acting bronchodilators as required.
Encouraging patients with COPD to stop smoking is one of the most important components of their management. All COPD patients still smoking, regardless of age, should be encourages to stop, and offered help to do so, at every opportunity.
Since the cause of epilepsy is often not clear, it generally is not possible to prevent it. Head injury, a common cause of epilepsy, may be preventable. Always wear your seat belt in the car and a helmet when riding a bike or motorcycle, skiing, skating, or horseback riding.
Epilepsy is a condition that affects the brain and causes repeated seizures. The condition can start at any age, although it most often begins during childhood. It’s not often possible to identify why a person develops this condition, although in some cases it can be associated with damage to the brain.
The cells in the brain, known as neurons, conduct electrical signals and communicate with each other in the brain using chemical messengers. During a seizure, there are abnormal bursts of neurons firing off electrical impulses, which can cause the brain and body to behave strangely.
The main symptoms of epilepsy are repeated seizures. There are many different types of seizure, depending on the area of the brain affected. People with epilepsy can experience any type of seizure, although most people have a consistent pattern of symptoms. Seizures can occur when you are awake or asleep. Doctors classify seizures by how much of the brain is affected. There are:
- Partial (or focal) seizures this is where only a small part of the brain is affected,
- Generalized seizures this is where most or all of the brain is affected,
- Some seizures do not fit into these categories and are known as unclassified seizures.
You may be taking one or more medicines to prevent seizures. To get the most benefit from them, you need to consistently take the right dose of the right medicine at the right time.
Treatment for epilepsy is used to control seizures, although not everyone with the condition will need to be treated. It may sometimes be possible to control your epilepsy solely by avoiding things that trigger your seizures, such as sleep deprivation and alcohol.
A detailed history should be taken to exclude previous myoclonic, absence or partial seizures as patients with undiagnosed epilepsy may present with a single generalised tonic-clonic seizure.
Pregnancy and HRT
Women with Epilepsy who are of child bearing age need additional advice about issues such as contraception and pregnancy. The choice of epilepsy medication for women may be influenced by factors that include potential teratogenicity of the AED, interactions with the oral contraceptive and cosmetic side effects.
In order to improve risk factor and symptom management we hold an Epilepsy management clinic. The clinic is undertaken by our Practice Nurse. When attending please bring all your medication that you are currently taking for your illness.
There are changes in lifestyle which can help prevent Hypothyroid. Here are three major areas which would improve your health and lower the risk of getting hypothyroid.
Hypothyroid is where your thyroid gland doesn’t produce enough hormones this is known as an Underactive Thyroid Gland. Common signs of an underactive thyroid include tiredness, weight gain and depression.
Common symptoms of hypothyroid include:
- Being sensitive to cold,
- Weight gain,
- Slow movements and thoughts,
- Muscle aches and weakness,
- Muscle cramps,
- Dry and scaly skin,
- Brittle hair and nails.
An underactive thyroid (hypothyroidism) is usually treated by taking daily hormone replacement medication. If blood tests suggest you may have an underactive thyroid, but you don't have any symptoms or they're very mild, you may not need any treatment. In these cases, your GP will usually monitor your hormone levels every few months and prescribe medication if you develop symptoms.
the dose of thyroxine is adjusted according to your tft result.
Our Practice aims to provide clinics for all Hypothyroidism patients with counselling and advice regarding their condition. We also aim to achieve maximum control of the patient’s conditions. The clinic is run by the Practice Nurse where affected patients are invited to attend for monitoring on a regular basis.
Diagnosis and follow-up:
Stage 1: identification
Hypothyroidism may present with the following symptoms, signs or findings:
- Weight gain
- Memory and mental impairment
- Dry skin and cold intolerance
- Decreased concentration
- Coarseness or loss of hair
- Irregular or heavy periods and infertility
- Myalgia s (muscle pains)
- Raise blood fat levels
- Reflex delay in the relaxation phase
- Slow heart rate and hypothermia
- Ataxia (unsteadiness and problems with co-ordination)
- Myxedema – fluid infiltration of tissues
Patients presenting with symptoms suggesting hypothyroidism should be tested by blood test for thyroid stimulating hormone (TSH).
Eating a healthy diet, getting regular exercise, and taking time out for fun and relaxation, may work together to prevent a depressed mood. If you or a loved one are experiencing symptoms of depression that last for more than one or two weeks you should speak to the GP.
Mental health is associated with a person’s emotional, psychological, and social well-being. This directly affects the way we think, feel, and act. This condition also helps determine how we handle stress, relate to others, and make choices.
Depression is a very serious and common condition that affects our mood, thoughts and body. It can present itself through sadness, guilt and anxiety. Depression can also lead to a lack of drive to carry out basic self-care such as appetite or lack of sleep.
Symptoms of poor mental health including depression can be complex and vary widely between different people. But as a general rule, if you're depressed you may feel, sad, hopeless and lose interest in things you used to enjoy. The symptoms may persist for weeks or months and are bad enough to interfere with your work, social life and family life.
If you have depression, possible forms of treatment are available to help:
- Antidepressants are tablets that treat the symptoms of depression or poor mental health,
- Your GP can recommend a combination of therapy, which would involve you taking a course of antidepressants plus talking therapy, particularly if your depression is quite severe,
- Mental health teams can be availed of for help, if you have severe depression. You may be referred to a mental health team made up of Psychologists, Psychiatrists, Specialist Nurses and Occupational Therapists. These teams often provide intensive specialist talking treatments as well as prescribed medication.
Mental Health clinics are set up to help diagnose and treat all patients with mental health problems and prevent relapse, to promote a healthy lifestyle and social interaction. Our Practice runs a Clinic which is run by the Practice Nurse where patients are invited to attend for monitoring on a regular basis.
Mental Health protocol
We aim to diagnose and treat all patients with mental health problems and prevent relapse, to promote a healthy lifestyle and social interaction and ensure compliance.
Between 10% and 15% of women have postnatal depression after childbirth. Severely depressed mothers may resort to suicide, which is the second most common form of maternal death in the year after birth, and may require hospital admission. Inform social support can reduce the risk of postnatal depression. Health visitors can use their routine contacts with mothers to identify postnatal depression and treat its milder forms. Prevention
Severe eating disorders such as anorexia and bulimia can result in long term ill health, and may cause death. Most eating disorders can be managed within primary care. Dietary education and monitoring of food intake are effective components of treatment. Antidepressants may be effective in panic and eating disorders.
Individuals with severe disorders should be referred for specialist assessments, including a full medical and psychiatric assessment.
Panic Attacks / Anxiety disorders
Panic attacks, phobias, or persistent generalised anxiety can impede a person’s ability to work, form relationships, raise children, and participate fully in life. GP’s often see anxiety, mixed anxiety and depressive disorder, which may be associated with high levels of disability. People who have anxiety symptoms usually smoke more, and may drink more alcohol too, increasing their risk of ill health.
Each year, one woman in every 15 and one man in every 30 will be affected by depression, and every GP will see between 60 and 100 people with depression. Most of the 4,000 suicides committed each year are attributed to depression.
Anti-depressant medication is an effective treatment for depression. Different groups of anti-depressants (tricyclics, SSRI’s etc.) have all been shown to be more effective than placebo in treating depression. However, people with depression often feel they do not receive adequate information concerning their treatment.
Depression can also be treated by structured psychological therapies, such as cognitive behaviour therapy.
The best way to help prevent Hypertension is to make lifestyle changes which can help prevent and lower high blood pressure:
- Reduce the amount of salt you eat and have a generally healthy diet,
- If you drink too much then you will need to cut down your alcohol intake,
- Lose weight if you're overweight,
- Exercise regularly,
- Cut down on caffeine,
- Stop smoking,
- Try to get at least six hours of sleep a night.
Some people with high blood pressure may also need to take one or more medicines to stop their blood pressure getting too high.
Hypertension (high blood pressure) has rarely noticeable symptoms but if left untreated, it can increase your risk of problems such as heart attacks or stroke. The only way to find out if your blood pressure is high is to have your blood pressure checked.
If your blood pressure is extremely high, there may be certain symptoms to look out for including:
- Severe headache,
- Fatigue or confusion,
- Vision problems,
- Chest pain,
- Difficulty breathing,
- Irregular heartbeat,
- Blood in the urine,
- Pounding in your chest, neck or ears.
Whether medication is recommended depends on your blood pressure reading and your risk of developing problems such as heart attacks or strokes. Below are some changes you could make to your lifestyle to reduce high blood pressure as follows:
- Reduce your salt intake to less than 6g (0.2oz) a day – find out how you can reduce the amount of salt in your diet,
- Eating a low-fat balanced diet including plenty of fresh fruit and vegetables,
- Exercise regularly
- Reduce the intake of alcohol,
- Lower your weight, using recommended guidelines about losing weight if you're overweight.
Our Practice Nurse led clinic is aimed to evaluate all newly-diagnosed hypertensive patients, to manage those found to have borderline or mild hypertension and at high cardiovascular risk and to manage established hypertensives. Practice Nurses measure blood pressure and cholesterol of all hypertensive patients at least twice yearly, record their smoking status and offer smoking cessation advice to all smokers at every clinic attendance.
Follow up for treated Patients
- Frequency of visits will depend on the overall risk category of the patient as well as on the level of blood pressure.
- Patients with stable hypertension will be reviewed every 6 months.
- Routine follow-up visits should be simple :
- Measure blood pressure and weight
- Enquire about general health, side effects and treatment problems
- Reinforce advice on non-pharmacological measures
- Test urine for protein, blood/glucose
- Check Urea & electrolytes after 10 days following commencement of therapy with ACE-inhibitors or angiotensin
Your brain is nourished by one of the body’s richest networks of blood vessels. Anything that damages blood vessels anywhere in your body can damage blood vessels in your brain, depriving brain cells of vital food and oxygen. Prevention of Dementia will usually involve making healthy lifestyle changes, such as:
- Eating healthily, for example, you may be advised to follow a low-salt diet to manage high blood pressure,
- Losing weight if you're overweight
- Stopping smoking
- Getting fit
- Cutting down on alcohol
Lifestyle advice - All patients will be offered lifestyle advice as appropriate:
- Stop smoking
- Dietary improvements to ensure improved health benefits
- Alcohol consumption
- Moderate Exercise were able
The lifestyle advice will follow a patient-centered with four stages:
- Eliciting the patients’ views, beliefs and reediness to change
- Explaining the nature of and reasons for the advice
- Negotiating and agreeing goals
- Supporting the patient to achieve and maintain change and can be reinforced by appropriate Health guidance.
Dementia is a syndrome that is associated with the ongoing decline of the brain by measuring Patients memory loss, thinking speed, mental agility, language, understanding and judgement. This will help understand the Patients ability to perform everyday activities.
People with dementia may have problems with short-term memory, keeping track of a purse or wallet, paying bills, planning and preparing meals, remembering appointments or traveling. Symptoms of dementia can include:
- Slowness of thought and processing of decisions,
- Difficulty with planning ahead,
- Trouble with understanding conversations,
- Problems with concentration,
- Mood or behavioural changes,
- Problems with memory and language,
Medication may also be offered to treat the underlying cause of vascular dementia and help stop it getting worse. These include:
- Medication for high blood pressure,
- Statins to treat high cholesterol,
- Medicines such as aspirin or Clopidogrel to reduce the risk of blood clots and further strokes,
- Anticoagulant medication, such as warfarin, which can also reduce the risk of blood clots and further strokes,
- Medication for diabetes.
Our Practice runs a Clinic for Patients with Dementia aiming to provide all patients and their carers/relations with the information and support they need. They allow people with dementia the opportunity to make informed decisions about their own care and treatment.
Our Practice aims to operate a combined care plan agreed by health and social services that take into account the changing needs of the patient with dementia and their carers. In addition an appointment will be offered to all patients with Dementia at least once annually.
The purpose of an annual review is to ensure that those patients with dementia and their carers are given the best opportunity to maximise their physical and psychological well-being by primary care staff with support from secondary care mental health services, social, community and voluntary sector care.
A basic dementia screen should be performed at time of presentation, usually within primary care, and should include:
- Routine haematology
- Erythrocyte sedimentation rate (ESR)/ Viscosity or C-reactive protein (CPR)/
- Biochemistry (including electrolytes, calcium, glucose, renal and liver function)
- Thyroid function tests
- Serum vitamin B12 and folate levels
A learning disability affects the way a person understands information and the way they communicate with others. People that have a learning disability may have difficulty understanding new or complex information, learning new skills and coping information independently.
Often learning disabilities are discovered at birth, while others are not diagnosed until much later on in life. Common signs of a person who may have learning disabilities include the following:
- Difficulty with reading and/or writing,
- Problems with math skills,
- Difficulty remembering,
- Problems paying attention,
- Trouble following directions,
- Poor coordination,
- Difficulty with concepts related to time,
- Problems staying organized.
Our Practice Nurse/Learning Disability Nurse provide an initial health assessment for patients on the register and provision of a patient held action plan, which will be reviewed on annual basis.
Our Practice Learning Disability Clinics work in partnership with our local Trust to provide optimum service to patients with Learning Disabilities. In addition we liaise with the Trust Health Facilitator to establish an accurate register of patients where services are to be provided.
The aims of all 75+ screening clinics is to ensure that older patients do not suffer unnecessarily from illness that can be prevented or alleviated by clinical intervention, referral and education making sure that older patients continue to feel valued members of the practice population.
- Provision for patient support ,
- Opportunity for patients to discuss any concerns which they may have over medication or health with regard to which they might not otherwise make an appointment with a clinician.
Practice Nurse will set review intervals for each individual patient. This is normally 1 year. However some patients may require to be reviewed sooner e.g. 6months
Although unlikely patients discovered to have certain risk factors should be passed on to the appropriate clerical officer for review.
Reduction of risk factors
Patient’s lifestyle is discussed (as explained above) to try and reduce illness e.g. counselling given regarding smoking diet, food supplements, exercise etc.
- All Patients will be offered lifestyle advice as appropriate.
- Stop smoking
- Alcohol consumption moderate exercise were able
- Keeping the mind active.
The lifestyle advice will follow a patient-centred with four stages:
- Eliciting the patients’ views, beliefs and readiness to change
- Explaining the nature of and reasons for the advice
- Negotiating and agreeing goals
- Supporting the patient to achieve and maintain change
And can be reinforced by appropriate Health Promotion materials
Ensure any referrals done by the Practice Nurse are sent off on the same day or at the latest the day after clinic is held.
In order to ensure enjoyment of the best possible health, for all our housebound patients, we would like to offer you a health check in your own home. At this consultation our Practice Nurse will carry out appropriate tests under our direction. She will also be available to discuss any worries which you may have and refer back to as necessary.
Coronary Heart Disease/Atrial Fibrillation/Heart Failure
Coronary heart disease cannot be cured, but recent progress in the research and development of new medicines and significant improvements in surgical procedures have meant that the condition can now be reduced and the functioning of the heart improved.
You can prevent and control coronary heart disease (CHD) by actively managing the associated risk factors by introducing a heart-healthy lifestyle and aiding this with medicines. Examples of risk factors which you have the ability to control your blood cholesterol, blood pressure and your body weight.
Overview – Coronary Heart Disease
Coronary Heart Disease is a term that describes what happens when your heart’s blood supply is blocked or interrupted by a buildup of fatty substances in the coronary arteries. Symptoms of Coronary Heart Disease include chest pain, heart attacks and heart failure.
Overview – Atrial Fibrillation
Atrial Fibrillation is a heart condition that causes irregular and fast heart rate. This can in turn cause dizziness, shortness of breath, tiredness or heart palpitations.
Overview – Heart Failure
Heart failure means that the heart is under stress and unable to pump blood around the body properly. It usually occurs because the heart has become too weak or stiff.
As the three diseases are closely associated the symptoms generally include a build-up of plaque which continually builds up in your coronary arteries. Further symptoms include the following indicators:
- Heart palpitations (feeling that your heart is racing or fluttering),
- Awareness that the heart is beating,
- Chest pain, pressure, or discomfort,
- Abdominal pain,
- Shortness of breath,
- Fatigue or lack of energy,
- Exercise intolerance.
To prevent the onset of Coronary Heart Disease and other related illnesses, lower your blood pressure which will prevent blood clots. This will help to prevent or delay the need for surgery. Reduce your heart's workload and relieve coronary heart disease symptoms through a healthy lifestyle.
Our Practice runs a Nurse led Clinic aiming to improve the quality of life of patients with Coronary Heart Disease, Atrial Fibrillation and Heart Failure. The objective is to reduce the chance of heart attacks/strokes and to assess each patient’s health beliefs and enable them to make an informed choice about pursuing healthy lifestyle options.
Standards and criteria
To identify all patients with established cardiovascular disease and offer them comprehensive advice and appropriate treatment to reduce their risks.
The systematic care of patients with arterial disease will be shared between patients’ doctor and the nurse-run clinic.
To identify all people at significant risk of cardiovascular disease but who have not yet developed symptoms, and offer them appropriate advice and treatment.
Priority will be given to the management of patients with established Arterial Disease, and to those patients who are already identified with hypertension and diabetes. Some category 2 patients will be managed through diabetic, Stroke/TIA Clinics.
Patients should be seen on at least an annual basis and more frequently if any associated risk factors are not meticulously controlled.
Patients with hypertension
Patients with diabetes or hypertension will have their cardiovascular risk assessed when they are reviewed, and if their risk is comparable to the risk in patients with established arterial disease, (>30% in 10 years), they will be managed in the same way.
All patients will be offered lifestyle advice as appropriate. Patients will be advised to reduce their cardiovascular risk by:
Eating a prudent diet, low in saturated fat, supplemented with polyunsaturated fats and fish oils, and high in fresh fruit and vegetables.
Being moderately physically active, keeping alcohol consumption below the recommended limits of up to 3-4 units per day for men and up to 2-3 units per day for women
Smoking is the greatest cause of illness and premature death in the UK. You reduce your risk of getting serious disease no matter what age you give up. However, the sooner you stop the greater reduction in the risk.
Some people can give up easily. Willpower and determination are the most important aspects when giving up smoking. However, nicotine is an addictive drug and many people find giving it up a struggle.
Benefits of quitting smoking
- After 20 minutes – Your pulse rate returns to a normal value,
- After 8 hours -Nicotine and carbon monoxide levels in blood reduce by more than half and oxygen levels return to normal,
- After 48 hours - Carbon monoxide will be eliminated from the body. Lungs start to clear out mucus and other smoking debris. There is now no nicotine in the body. Increased ability to taste and smell,
- After 72 hours - Breathing becomes easier. Bronchial tubes begin to relax and energy levels increase.
If you want to stop smoking, several different treatments are available from various outlets. Treatment can be given by your GP on prescription to help you beat your addiction and reduce withdrawal symptoms.
The main options are:
- Nicotine replacement therapy (NRT), a 12 week course can be provided on an NHS script.
- Varenicline (Champix), a 12 week course can be provided on an NHS script.
- Bupropion (Zyban),
The best treatment for you will depend on your personal preference, your age, whether you're pregnant or breastfeeding and any medical conditions you have. Speak to your GP or an NHS stop smoking adviser for advice.
The Practice Nurse runs a Smoking Cessation Clinic to assist patients in kicking the habit. These clinics are run in accordance with patient demand. Various treatments are discussed and implemented to help your chances of quitting.
Thinking about stopping:
- Raise the issue
- Build up a picture of your habit
Deciding to stop:
- Reinforce interest in stopping
- Gain support and help to finally stop
- Gain practical tips and advice on how to stop smoking
- Develop coping strategies for perceived problems
- Maintain your interest as the days and weeks pass and give positive encouragement
- Have hard facts at hand to counterbalance those excuses for relapse
Nicotine replacement therapy
When stopping smoking
Two factors are important when stopping smoking-motivation and dependence. If you lack motivation to stop smoking or if you are motivated by others then this needs to be tackled first. Ask yourself how you feel about your smoking and how you feel about stopping. If you feel that your smoking is a problem and are motivated to stop please make an appointment with the nurse to discuss.
NRT works by delivering a controlled dose of Nicotine into the body, in a lower dose than cigarettes and with none of the potentially disease-causing agents that are in tobacco smoke. It is available in a variety of forms e.g. gum, patch, inhalator, lozenge, micro tab and nasal spray. They are all equally effective and the choice can be patient led.
All smokers should be offered advice about how to stop smoking, including advice on the use of nicotine replacement therapy and other therapy.
Smoking doubles the risk of stroke and CHD. After smoking cessation, risk of stroke and CHD returns to that of people who have never smoked.
- Patients should be advised to:
- Reduce weight, if appropriate,
- Reduce total and saturated fat intake, replace with some increase in polysaturated and monosaturated fat and oily fish consumption
- Reduce salt intake
- Increase fruit and vegetable consumption (5 portions per day).
If appropriate, patients should be advised to take dynamic exercise (e.g. brisk walking for 20 minutes per day.
Patients should be advised to limit alcohol consumption (e.g. <21 u/week for men; <14u/week for women).
A Stroke or TIA is a serious, life-threatening medical condition that occurs when the blood supply to part of the brain is cut off. Strokes are usually caused by one of three things: Low blood flow at a narrow part of a major artery carrying blood to the brain, such as the carotid artery, a clot blocking blood flow to the brain or a haemorrhage into the brain tissue.
Signs of Stroke in both men and women
- Sudden numbness or weakness in the face, arm, or leg, especially on one side of the body,
- Sudden confusion, trouble speaking, or difficulty understanding speech,
- Sudden trouble seeing in one or both eyes,
- Sudden trouble walking, dizziness, loss of balance, or lack of coordination
The best way to help prevent a stroke is to eat a healthy diet, exercise regularly, and avoid smoking and drinking too much alcohol.
When stroke strikes act F.A.S.T.
- Face – Has it fallen on one side?
- Arms – Can they raise their arms?
- Speech – Is it slurred?
- Time – If you notice any of these signs make the call - Dial 999
Stroke and TIA’s are medical emergencies. If you have stroke symptoms, call 999 right away. Do not drive to the hospital yourself either get someone to take you there or call an ambulance. During a stroke, every minute counts.
A Stroke/TIA Clinic is run by the Practice Nurse to monitor patients and to reduce substantially the risk of stroke or TIA in the future. They aim to increase public awareness of the urgency of calling emergency services and gaining admission to stroke unit at onset of stroke.
Oral anticoagulation reduces the risk of recurrent stroke in patients with non-valvular AF and recent ischemic stroke. These medications will aim to reduce substantial the risk of Stroke or TIA in the future.
Aims and objectives
To provide Palliative care of the chronically and terminally ill, primarily directed towards improving the quality of life at a time when the goal is not cure. The main goal is to ease pain and other symptoms, to help the person have a clear mind and support the person, family and their friends.
The emphasis of palliative care is on the control of pain and symptoms, and meeting physical, emotional, spiritual, social and cultural needs. It is multidisciplinary in its approach, encompassing the person, family, caregivers and the community in its scope and extends to include grief and bereavement.
- Symptoms controlled as well as possible
- Place of care –enabled to die well in the place of their choice.
- Security and support – less fear/anxiety better information, advanced care planning
- Carer’s – supported and informed
- Staff – Confidence, communication, co-working improved referencing – Gold Standards Framework.
Who is involved?
Different health and social care professionals may be involved, depending on the needs of the patient. Hospital doctors and Nurses, your GP, community Nurses, hospice staff and counsellors may all be involved, as well as social care staff, chaplains (of all faiths or none), physiotherapists, occupational therapists or complementary therapists
How do I find out about end of life care services in my area?
If you are approaching the end of life, or caring for someone who is, and you want to find out about the care and support available, your first step is to speak to your GP or call the number your healthcare professionals have given you.
Palliative Care meetings are held on a monthly basis to ensure a high quality Care is provided for all our patients that need it. This service is primarily directed towards offering more choice taking into consideration Patient priorities and preferences for care and improving quality of life overall.
Cytology and Well Woman Clinic
A patient with a parent who carries the genetic form of ovarian cancer has a 1:3 risk of contracting ovarian cancer themselves. Investigations include measurement of serum Ca-125, and transvaginal ultrasound screening.
There are many early stages of cervical cancer and if picked up early this is totally curable by simple treatment with no large operation necessary. Screening is normally carried out by the Practice Nurse or you can make an appointment with the doctor whom you normally attend.
It is very important for all women aged between twenty-five and sixty-four years old to have a cervical smear test every three years until age 50 then ever five years up until age 64. Women who have provided an abnormal sample prior to their 64th birthday can continue in the programme until follow-up is complete.
We operate a screening program based on current government guidelines to which patients are invited to attend in order to obtain a health check, a breast examination and a cervical smear.
Family history of Ovarian Cancer
Screening is appropriate for:
- Families with a history of ovarian cancer – screening is recommended for women with a family history of ovarian cancer in two 1st or 2nd degree relatives of any age and also in women with an affected identical twin.
- Families with a history of ovarian and breast cancer – Screening is recommended for women with a family history of ovarian cancer in one first degree relative with breast and ovarian cancer and also in women with two or more relatives with breast and/ or ovarian cancer.
- Lynch syndrome – hereditary (autosomal dominant) non-polyposis colon cancer, ovarian and uterine cancer. Family history of early age onset tumor’s at a variety of sites. Bowel, uterine and ovarian screening recommended.
Eating a healthy, balanced diet is recommended for everyone. It can help prevent many serious health conditions, including heart disease, diabetes and many other forms of cancer, as well as osteoporosis. Calcium is important for maintaining strong bones so supplements can help with this.
Osteoporosis is a bone condition that weakens the bones. In turn it can result in the weakened bone breaking much more easily than before. This condition can develop slowly over a few years and is often first diagnosed due to a fall or sudden impact.
As the bones of the skeleton get weakened by osteoporosis, you may encounter signs and symptoms that include:
- Back pain, caused by a fractured or collapsed vertebra,
- Loss of height over time,
- A stooped posture,
- A bone fracture that occurs much more easily than expected.
One of the main forms of treatment is to ensure you're maintaining sufficient levels of calcium and vitamin D.
The key messages for older people and their family and Carer’s include:
- Prevent falls where possible as the older you are the higher the risk, there are measures you can take to prevent falls or reduce the harm,
- Staying active and healthy through exercise and diet will likely keep you independent and reduce your risk of falling,
- If you're unsteady on your feet or fall, speak to your GP so that possible causes of falls, such as poor eyesight, certain medications, and poor muscle strength and balance, can be identified and treated.
Our Practice is committed to working to ensure that our patients are offered the best possible care by running Practice Nurse led clinics for patients that have Osteoporosis. Bone health is an important consideration for many men and women over the age of 50 and for those at risk of bone fractures.
Women and Osteoporosis
Women are more susceptible to osteoporosis because bone loss becomes more rapid for several years after the menopause, when sex hormone levels decrease. In addition, women tend to have smaller bones than men and in general live longer, with loss of bone tissue continuing for longer, making fragility fractures more likely.
Men and Osteoporosis
Osteoporosis is a condition that not just affects women, although it is a common misconception. If you are a man, you might be thinking osteoporosis can’t affect you as it’s a “women’s problem”, but in fact one in every five men break a bone after the age of 50 years because of low bone strength.
Osteoporosis in children
There is an unusual condition in children called “idiopathic juvenile osteoporosis” in which broken bones occur following minor levels of trauma without an apparent underlying problem. Sometimes, Osteoporosis in children occurs because of other factors such as use of glucocorticoid steroids, brittle bone disease (osteogenesis imprafecta) or because a child is immobile.
Your bones have several functions. They give your body its overall structure and provide support and protection for your internal organs. They store calcium and other minerals and work with your muscles to allow your body to move. They also contain bone marrow, which is where your blood cells are produced.
Presently, there is no feasible way to prevent arthritis. In some cases preventing incidents where possible such as sports injuries and accidents which hurt your body can significantly reduce risk of arthritis. Avoiding sports injuries through proper equipment, training and safe play can prevent ACL ((anterior cruciate ligament) tears that may lead to osteoarthritis in a few years or several decades later. There is hope that that someday some or all types of arthritis and related conditions can be prevented.
The major objectives for treating patients with rheumatoid arthritis is managing the symptoms of the disease and preserving joint structure with the ultimate goal of disease remission.
In addition to the above it is important to have a healthy and balanced lifestyle:
- Eating healthily,
- Losing weight if you're overweight
- Stopping smoking
- Getting fit by exercising regularly
- Cutting down on alcohol
Rheumatoid arthritis is a long-term condition that causes pain, swelling and stiffness in the joints. The symptoms usually affect the hands, feet and wrists. The symptoms vary from person to person. They can come and go, and may change over time. You may occasionally experience flares when your condition deteriorates and your symptoms become more severe.
Diagnosis and symptoms of Arthritis
Rheumatoid Arthritis can start in many ways, and can be difficult to recognise. It can come on slowly and be mild, or it can start suddenly and cause intense pain that surges within a few hours. The signs and symptoms can come and go over time. It might cause the classic issues of joint pain, swelling and stiffness, or it may first cause health problems that seem unrelated, like fatigue or a rash. Early signs of arthritis pain might be mistaken for an injury or a result of too much activity.
Rheumatoid arthritis will display symptoms of joint pain and loss of movement and including:
- Joint pain can occur with or without movement and can be severe enough to limit movement,
- Joint tenderness can be discomfort, pain or inflammation arising from any part of a joint,
- Joint swelling can cause pain or stiffness,
- Joint warmth can be an indication of rheumatoid arthritis,
- Loss of joint range of motion due to joint stiffness.
Treatment for rheumatoid arthritis can help reduce inflammation in the joints, relieve pain, prevent or slow joint damage, reduce disability and enable you to live as active a life as possible.
Although there's no cure for rheumatoid arthritis, early treatment and support including lifestyle changes, medication, supportive treatments and surgery can reduce the risk of joint damage and limit the impact of the condition.
Our Practice holds a Monitoring Clinic where the Practice Nurse will work to achieve the best possible monitoring of your condition and improve risk factor and symptom management of Rheumatoid Arthritis.
Rheumatoid arthritis is an autoimmune disease. This means your immune system, which usually fights infection attacks the cells that line your joints by mistake, making the joints swollen, stiff and painful.
If you have rheumatoid arthritis this causes the thin layer of cells (synovium) covering your joints to become sore and inflamed, releasing chemicals that damage:
- Cartilage – the connective tissue between bones
- Tendons – which connect bones to muscle
- Ligaments – the tissue which connects bone and cartilage
If the tissue isn’t treated, these chemicals gradually cause the joint to lose shape and alignment. Eventually, it will destroy the joint completely.
There are a number of things that may increase the risk of developing arthritis, including
- Genes – there’s evidence that rheumatoid arthritis can run in families,
- Hormones – rheumatoid arthritis is more common in women
- Smoking – some evidence suggests that people who smoke are at an increased risk of developing rheumatoid arthritis.
Management of condition
To improve your management of arthritis it is recommended that you:
- Take charge of your treatment plan by keeping track of symptoms, pain levels, medications and possible side effects so together with your GP you can discuss what works best for you.
- It is important not to allow pain and fatigue to overwhelm you,
- Exercise is beneficial to for managing arthritis and your overall health.
- Balance activity with rest, pace yourself throughout the day and take breaks to conserve energy.
- Eat a healthy diet combined with exercise to help or keep and maintain a healthy weight. Also adding foods with anti-inflammatory properties that are rich in antioxidant’s can help lower inflammation.
Peripheral Arterial Disease
An often effective treatment for PAD symptoms is regular physical activity. You might want to begin slowly, but simple walking regimens, leg exercises and treadmill exercise programs can ease symptoms.
There are many factors which contribute to the onset of Peripheral Arterial Disease as follows:
- High Cholesterol
- Diet and Weight
Vascular disease can also be a hereditary condition. If you have a history of vascular disease in your family, you may want to discuss this with your health care practitioner.
Peripheral Arterial Disease (PAD) is a common condition, in which a build-up of fatty deposits in the arteries restricts blood supply to leg muscles. Symptoms of PAD included hair loss on your legs and feet, numbness/weakness in the legs, ulcers on your legs and feet, changing skin colour on your legs and feet etc.
There are various methods of testing for Peripheral Arterial Disease Ankle Brachial Pressure Index (ABPI) which is a method of assessing the blood supply to your feet by comparing blood pressure in both arms. If you have atherosclerosis of your leg arteries, there’s likely to be a lower blood pressure in your feet.
In some people, the disease progresses and the amount of blood able to go down the leg is not enough to supply the nutrients and oxygen to their feet. In cases like this, the individual will get pain in their feet even when they’re not moving. Peripheral artery disease symptoms include:
- Painful cramping in your hip, thigh or calf muscles after certain activities, such as walking or climbing stairs (claudication),
- Leg numbness or weakness.
- Coldness in your lower leg or foot, especially when compared with the other side.
Treatments for peripheral arterial disease can include the following measures:
- Managing your risk factors, including high blood pressure
- Anti-platelet medication (prevents blood clots forming on the atherosclerosis inside your arteries.
- Peripheral vasodilators (medication to relax your blood vessels and allow blood to flow more easily)
- Taking regular exercise
- Statins (drugs used to lower cholesterol levels)
Invasive therapy for some people with severe vascular disease, invasive therapy such as balloon angioplasty or stent insertion may be considered.
An Annual assessment of ABPI, patients are reviewed and monitored as well as given advice and treatment as needed. PVD patients are reviewed on an annual basis.
Needs assessment involves the identifying of Patient needs. These measures will address what your needs are and how they impact your wellbeing. This will help address how you wish to live your life and whether there are certain hurdles you would like overcome which currently you are unable do so because of your care and support needs.
The Practice Nurse visits housebound patients within our catchment area in their own homes to offer advice and support or by referring Patients on to other agencies where necessary.
Residential care is available for those in need. Residential care can be provided on a permanent basis for older people, homes for younger adults with disabilities and homes for children. Care homes may be privately owned or run by charities or local councils. Small care homes are available in small home-like dwellings, while others will be based in larger communal centers.
One of first decisions to consider is whether the care home should provide nursing care, or just standard personal care. Going into a care home is a major commitment for your future may involve changing where you live and potentially committing to paying a fee for your accommodation and personal care
Care homes for adults aged 16 – 65
There are also residential care homes that provide care and support for younger adults with for example, severe physical disabilities, learning disabilities, brain injury resulting from an accident, or mental health problems.
They can care for adults with more than one condition, and some homes will have expertise in providing care for adults with alcohol and drug dependency. These care homes may offer permanent residence or provide care for a temporary period.
If you are assessed by social services and are found to be eligible for support, the next stage is to draw up a care and support plan. A Care Plan outlines how your care and support needs will be met. You should be fully involved in the preparation of your care plan, and you and anyone else you request should also get a written copy.
The assessment will start to consider how your care needs might be achieved. This could include identification how preventative services like simple aids or adaptions can be provided, such as:
- Devices to open jars and tins more easily
- Personal care such as washing or dressing
- Housekeeping or domestic work, such as vacuuming
- Cooking or preparing meals
- Nursing or health care
Home care can be very flexible in order to meet your needs which can also include:
- Long term 24-hour care
- Short breaks for an unpaid family carer
- Emergency care
- Day care.
Services that can help you stay safe and well in your home on a long-term basis, these services, often known as “supported living services”, can include financial help with mediation, advocacy, social and practical support.
If you think you might benefit from some help at home, the first thing to do is to contact your social services department to ask for an assessment of your care and support needs. Otherwise you can speak to your GP for help.
Review of your care plan
Your care plan should be reviewed by social services within the first three months, and then at least annually. The review looks at whether the outcomes identified in the care plan are being achieved. It should also review these goals to make sure they are still appropriate in case your care and support needs haven’t changed, and also to check that any risk assessments are up to date. If your needs have changed your plan will be revised. This may involve a needs assessment and financial assessment.
The Practice Nurse will aim to review all patients on a regular basis to ensure that each Patients needs are met (including those where disease is not active at least annually). In addition the Nurse will carry out all screening tests relevant to the patient’s disease on a regular basis.
Outpatient surgery allows patients to return home on the same day that a surgical procedure is performed. Outpatient surgery is also referred to as ambulatory surgery or same-day surgery.
Outpatient surgery eliminates inpatient hospital admissions, reduces the amount of medication prescribed, and uses a doctor’s time more efficiently. Outpatient surgery is suited best for healthy people undergoing minor or intermediate procedures (limited urologic, ophthalmologic, or ear, nose and throat procedures involving the extremities).
Preparation for surgery
A Surgeon will evaluate the patient before proceeding to surgery. If there are any issues that need attention before proceeding to surgery, the surgeon may request the patients GP, Family doctor for advice, especially in the case of Patients with complex medical conditions before proceeding into surgery. Please consider the following when preparing for your surgery:
- Don’t drive to your surgery if possible arrange for someone to bring you,
- Remember not to eat or drink before your operation if instructed, if want to consult with your GP then please contact your GP for advice if in doubt,
- Don’t drink or smoke alcohol 24 hours before your operation,
- If you are taking any regular medication, please bring that with you.
On the day of surgery
When you arrive at the Day Centre Surgery Centre, report to reception, where your details will be checked. You’ll then be called by a nurse who will admit and prepare you for theatre. Please note that friends and family are not permitted into this area.
The nurse will check the information from your Pre-operative assessment with you for any changes. Please let the nurse know if you have any changes or concerns. You will then need to dress in a theatre gown, with your dressing gown and slippers over the top. Your surgeon and anesthetist will then see you and you may also see the physiotherapist if needed.
After your operation
After your operation, you’ll be transferred to the recovery area. If you had a General Anesthetic you’ll be monitored within the recovery area and will be discharged when you have recovered and have had a light meal, usually toast. You can expect to be in the recovery area for at least a few hours.
A friend or family member will then be able to pick you up and bring you home. Generally most patients will be contacted after surgery to ensure that you’re recovering well and have understood all of your discharge information. If you have any concerns about your recovery you can discuss this by contacting the nurse or GP.
Outpatient surgery for children
For Parents and caregivers surgery performed on children can be a very difficult and strenuous situation. The benefit of Outpatient surgery enables parents and caregivers to remain in contact with the child and decreasing separation from their family and home.