Volume 2, Number 2, April-May-June 2009

EDITORIALMeeting the challenge of keeping up-to-date
Professor Mike Kirby

“Medicine has been caught up, like all other human activities, in the technological revolution of the last hundred years. It has become a restless critical discipline,trying desperately to encompass an explosive increase in knowledge in the biological sciences.”
(Harry Keen, Professor of Human Metabolism, Guy’s Hospital, London; in the preface to Triumphs in Medicine. Paul Elek, London and New Hampshire USA,1976)

EDITORIALConnecting to Europe. An update on the EPCCS and how to register for Catalan CVD CPD this September
Richard Hobbs

JOURNAL REVIEWJournal Review

POPULAR
TOPICTOPICAL REVIEWSmoking cessation 3: nicotinic partial agonists in smoking cessation – varenicline and cytisine
Paul Aveyard, Amanda Parsons, Rachna Begh

Cigarette smoking is the most preventable cause of illness, death, and excess healthcare costs in the UK. Most smokers want to stop smoking and intend to stop at some point. In this third article in our series on smoking cessation in primary care, we look at the evidence for the use of nicotinic partial agonists, including cytisine, which is not yet available in this country, and varenicline, which is.

POPULAR
TOPICTOPICAL REVIEWNational Diabetes Information Service offers support
Bob Young

HOT TOPIC REVIEWReperfusion therapies for acute ST-elevation myocardial infarction
Deepak Goyal, Gurbir Bhatia, Karim Ratib, Rob Butler

POPULAR
TOPICHOT TOPIC REVIEWImproving outcomes in cardiovascular disease: An Invest to Saveguide for practice based commissioners
Matt Kearney, Hannah Chellaswamy

Context: Cardiovascular disease has an enormous impact on people’s lives. It is a major cause of disability and reduced life expectancy, and accounts for one third of all deaths. It consumes vast resources in primary and secondary care. It is also very preventable. Comparison of our mortality rates with those in countries such as Japan, France and Spain suggests that eight out of 10 CVD deaths in England could be avoided through improved treatment and active prevention. Yet, although many patients receive excellent care, there is significant variation between practices in the diagnosis and treatment of this group of conditions. In common with other long-term conditions, there is also substantial under-diagnosis. Such variation in management and delay in detection worsens patient outcomes and heightens health inequalities. It is also very expensive as it increases rates of complication and hospital admission.
Design: The Invest to Save guide reviews the extensive evidence base for promoting prevention and optimising treatment in CVD. It examines current gaps in prevention and treatment in primary care and provides a framework for practice based commissioning (PBC) groups to use savings to fund a more systematic approach to the management of CVD in primary care. The framework focuses on increasing case-finding in CVD risk, hypertension, atrial fibrillation and diabetes, targeting preventive interventions on those at high CVD risk and improving the management of those with established disease.

QUALITY MATTERSInsulin in type 2 diabetes: getting the balancing act right
Brian Karet

How much insulin does a patient with type 2 diabetes need for optimal glucose control? It can sometimes be a tricky balancing act to get the dose just right – too much increases the risk of hypoglycaemic episodes and too little risks poor glucose control and the associated long-term complications. In this article we review what the research and guidelines recommend in how to ensure each patient gets the best dose of insulin.

POPULAR
TOPICCVD REVIEWVenous thrombosis and thromboembolism
David Fitzmaurice

NEWSNews stories in this issue...