HCV Therapy: Treat now or wait?

The combination of first generation protease inhibitors, telaprevir or boceprevir with pegylated interferon and ribavirin has significantly improved response rates when compared to pegylated interferon and ribavirin alone. While safe and effective for many patients, the potential of current DAA based therapy has been limited by tolerability, especially in those with extensive co-morbidities. Newer therapies, likely with improved efficacy and safety profiles are under development, however the timing of availability of these agents remains speculative. The choice to treat with currently available therapy or to wait for newer therapy is complex. These decisions require understanding of unique patient characteristics as well as safety and efficacy of both available therapy and new therapies undergoing investigation.     

Tinkering and tailoring individual consultations: how practice nurses try to make cardiovascular risk communication meaningful

Aims and objectives. To explore the perspectives of practice nurses in their role of communicating cardiovascular risk to patients. Background. Nurses in primary care have for some time been engaged in cardiovascular risk discussions with patients. With the recent introduction of the NHS Health Checks, the focus on this work is set to increase. Design. Qualitative using a framework approach. Methods. Two focus groups and 16 semi-structured interviews were conducted with nurses purposively sampled from those working in primary care. Results. The nurses' accounts revealed the need to develop a relationship of trust and establish a level of relevance with each individual patient whilst discussing cardiovascular risk. Potential aspects of these discussions were as follows: working within a highly structured data-collecting task; time constraints and consideration of the individual's context. We used the idea of tailoring to describe how nurses navigate and constantly modify and pitch their approach for each patient they see in response to these constraints. Conclusion. We suggest that in order for risk to be made meaningful to patients, practice nurses recognise the need for such information to be embedded in the more reciprocal dynamics of nurse-patient consultations. From their perspective, success is often as much about not saying something, or saying it in a particular way, as saying anything accurately or consistently. Relevance to clinical practice. For practice nurses to be instrumental in the successful delivery of health prevention policy initiatives such as the NHS Health Checks, it is important to acknowledge their views and perspectives in undertaking this work. This study suggests that the nurses recognised the need for further skills and a refinement of approach for those health professionals involved.     

severe disease complicated by osteoporosis

In this illustrative case, rheumatoid disease changed an active, self-supporting woman into a disabled, dependent and depressed person. When disease activity is continuous, early efforts to prevent severe deformity take on great urgency. It is also important to alleviate the psychosocial impact of the disease, which may well be more than even a highly motivated patient can handle alone.