Chronic kidney disease (CKD) is an ongoing decline of renal function which may progress quite rapidly or develop slowly over many years. Due to the nature of the disease, it is linked to cardiovascular disease (CVD) and a host of symptoms, comorbidities, high mortality and reduced quality of life. The majority of CKD patients will be identified in primary care. Once diagnosed, patients are likely to become increasingly frequent attenders within general practice. It is therefore useful to have an overview of the disease process and the multifaceted care needs of this specific patient group. General practice nurses (GPNs) are vital members of the multidisciplinary team who are wellplaced to identify, monitor and provide ongoing support for patients with CKD.
Dementia is a progressive loss of the cognitive functions that are necessary for a person to live safely and independently. These include loss of memory, the ability to think logically and communicate effectively with others, and being able to care for yourself. In 2009 a national dementia strategy for England was launched in order to improve public and professional awareness, and to ensure high quality care at all stages, including early diagnosis and treatment (Department of Health [DH], 2009).
The strategy outlined a care pathway for people living with dementia and their families and carers from diagnosis through to end of life. This article will enable the reader to understand the importance of the dementia care pathway in supporting people to live well with dementia, to consider how the pathway is being developed and implemented in primary care and how general practice nurses (GPNs) can add value within their professional role.
Around 12 million people in the UK have been diagnosed with hypertension (i.e. blood pressure [BP] greater than or
equal to 140/90mmHg) and over five million people have undiagnosed hypertension, which, if left untreated, can lead to premature ill health and death (Blood Pressure Association, 2008).
The risks associated with increasing BP are continuous — with each 2mmHg rise in systolic BP there is a 7% increased risk of mortality from ischaemic heart disease and a 10% increased risk of mortality from stroke (Lewington et al, 2002). However, although BP-lowering strategies have been shown to significantly reduce the risk, population-based studies consistently demonstrate that patients are unaware of the causes and effects of hypertension, and around two-thirds of those diagnosed remain untreated or inadequately controlled (Falaschetti et al, 2009; Antikainen, 2010). This article re-examines the evidence and guidelines to see how we can improve practice within this important area of cardiovascular disease prevention.
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