Peripheral Vascular Disease in Primary Care PDF
Preview Peripheral Vascular Disease in Primary Care
Peripheral Vascular Disease in Primary Care CHRONIC DISEASES IN PRIMARY CARE Peripheral Vascular Disease in Primary Care ANITA SHARMA MBBS, MD, DRCOG, MFFP General Practitioner Oldham Contributions by JOANNE WHITMORE and ADELE MARIE SCIMONE Forewords by MICHAEL TAYLOR General Practitioner Heywood, Middleton and Rochdale PCT DEEPAK BHATNAGAR Consultant/Senior Lecturer in Diabetes and Metabolism Royal Oldham Hospital University of Manchester Cardiovascular Research Group and GAIL RICHARDS Chief Executive, NHS Oldham First published 2011 by Radcliffe Publishing Published 2016 by CRC Press Taylor & Francis Group 6000 Broken Sound Parkway NW, Suite 300 Boca Raton, FL 33487-2742 © 2011 Anita Sharma CRC Press is an imprint of Taylor & Francis Group, an Informa business No claim to original U.S. Government works ISBN-13: 978-1-84619-435-1 (pbk) Anita Sharma has asserted her right under the Copyright, Designs and Patents Act 1998 to be identified as the author of this work. This book contains information obtained from authentic and highly regarded sources. While all reasonable efforts have been made to publish reliable data and information, neither the author[s] nor the publisher can accept any legal responsibility or liability for any errors or omissions that may be made. The publishers wish to make clear that any views or opinions expressed in this book by individual editors, authors or contributors are personal to them and do not necessarily reflect the views/opinions of the publishers. The information or guidance contained in this book is intended for use by medical, scientific or health-care professionals and is provided strictly as a supplement to the medical or other professional’s own judgement, their knowledge of the patient’s medical history, relevant manufacturer’s instructions and the appropriate best practice guidelines. Because of the rapid advances in medical science, any information or advice on dosages, procedures or diagnoses should be independently verified. The reader is strongly urged to consult the relevant national drug formulary and the drug companies’ and device or material manufacturers’ printed instructions, and their websites, before administering or utilizing any of the drugs, devices or materials mentioned in this book. This book does not indicate whether a particular treatment is appropriate or suitable for a particular individual. Ultimately it is the sole responsibility of the medical professional to make his or her own professional judgements, so as to advise and treat patients appropriately. The authors and publishers have also attempted to trace the copyright holders of all material reproduced in this publication and apologize to copyright holders if permission to publish in this form has not been obtained. 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Typeset by Pindar NZ, Auckland, New Zealand Contents Foreword by Michael Taylor vii Foreword by Deepak Bhatnagar ix Foreword by Gail Richards xi Preface xii About the author xiv Contributors xv Acknowledgements xvii 1 Varicose veins 1 2 Deep- vein thrombosis 13 3 Oral contraceptives and deep- vein thrombosis 25 4 Primary care oral anticoagulant management 29 5 Prevention of post- operative venous thromboembolism 37 6 The diabetic foot 41 7 Restless legs syndrome 57 8 Intermittent claudication 67 9 Leg ulcers 75 Adele Marie Scimone 10 Ankle Brachial Pressure Index 99 CONTENTS 11 The management of peripheral arterial disease in primary care 107 Joanne Whitmore 12 Tackling smoking: role of the GP 123 13 PAD: primary care service framework 135 14 Secondary care referral 139 15 Commissioning services for peripheral vascular disease 147 16 One- stop clinic 155 17 Multiple- choice questions 163 Index 175 vi Foreword by Michael Taylor Whether peripheral vascular disease is your passion or simply is recog- nised as an important component of your daily work, I have not the least hesitation in recommending this book to you. Peripheral Vascular Disease in Primary Care lays out in its chapters comprehensive information with the appropriate amount of detail to satisfy the most ardent general practitioner (GP) with a special interest in this subject. However, largely written and completely edited by a GP, Dr Anita Sharma, it has a style that is lean and sparse while nonetheless remaining a pleasure for any busy professional to read. It is a book to relish rather than devour in that it lends itself to reading one or a few chapters at a time rather than cover to cover in a single sitting. It is therefore an excellent source and reference book for all primary care professionals. This attribute is enhanced by the fact that the author has had the opportunity to consult widely, including specialist colleagues, both doctors and nurses. Having had the privilege and pleasure of contributing to the learning of students, nurses and registrars I am well aware of the suitability of this book for their purposes. They will be surprised with the descriptions of various pathologies simply explained, which they will seldom have noticed while working on hospital wards. As it goes to press this book is completely up to date and is unlikely to need revision for many years. Chapter 15, on commissioning services for peripheral vascular disease, is particularly timely as the National Health Service enters a period of austerity and GP commissioning. vii FOREWORD BY MICHAEL TAYLOR To summarise, this is a pragmatic book written by a GP and her team for GP teams; it should, therefore, fi nd a place on the bookshelves of busy practices. Dr Michael Taylor BSc, MB, ChB, MRCGP MICGP General Practitioner Heywood, Middleton and Rochdale PCT January 2011 viii Foreword by Deepak Bhatnagar Clinical professionals generally do not perceive the peripheral vasculature as an important site of disease as compared with the organs in the major cavities of the body. Neglected in this way, pathology in the peripheral vas- cular system often presents clinically in an advanced stage or in a dramatic, life- threatening manner. It is, therefore, important that symptoms and signs of disease are recognised early. Peripheral vascular disease is thought to be more prevalent in the older age group, but it is important to appreciate that it can occur prematurely in certain high-r isk groups such as people with diabetes or lipid disorders. As with most conditions lifestyle-r elated factors such as diet, smoking and obesity often play a major role in the causation of disease in the peripheral vasculature. This book offers the reader a very useful overview of peripheral vascular disease as well as suggesting models of care. Those working in primary care need to be able to recognise not only the acute presentations of peripheral vascular disease – such as critical limb isch- aemia or deep-v ein thrombosis – but also manage the preventative aspects and routine treatment of conditions such as varicose veins, intermittent claudication, leg ulcers and the diabetic foot. If managed poorly peripheral vascular disease can lead to problems with tissue viability. The good news is that the framework for diagnosing and managing many of these condi- tions in the community is gradually being put in place. This should avoid unnecessary admissions to hospital, but it is important that any manage- ment strategy is integrated with secondary care so that the patient pathway is seamless, with easy and timely access to any level of care. ix
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