Medical Centre

Although recent years have seen reduction in mortality and other events associated with coronary heart disease, we don't know if people with and without diabetes have benefited equally. In a paper published recently in Diabetes Care , Eszter Vamos and colleagues from the Department of Primary Care & Public Health at Imperial College London compared recent trends in hospital admission rates for angina, acute myocardial infarction (AMI), stroke, percutaneous coronary intervention (PCI), and coronary artery bypass graft (CABG) among people with and without diabetes in England. The found that in people with diabetes, admission rates for angina, AMI, and CABG decreased significantly by 5% , 5%, and 3% per year, respectively. Admission rates for stroke did not significantly change but increased for PCI in people with diabetes. People with and without diabetes experienced similar proportional changes for all outcomes, with no significant differences in trends between these groups.

The provision of after-hours primary care in the USA was discussed in a number of articles and letters published recently in the Annals of Internal Medicine . In a response to the articles. I discussed the relevance to the USA of England's experience in providing after-hours primary care. Many of the innovations recommended by by the authors of one of the articles in the Annals of Internal Medicine for the provision of after-hours primary care in the U.S. health care system are already present in England's NHS. These innovations are aimed at improving the care of people with emergencies and reducing pressures on emergency departments. For example, all residents of England have access to free after-hours primary care services from the NHS, either provided by their own primary care physician or by their local primary care trust. Despite the wide availability of primary care services and a readily accessible 24-hour helpline, patient attendance at emergency departments, urgent

End-digit preference (EDP) leads to clinicians recording specific end-digits (such as zero or five) more often than is expected by chance when measuring blood pressure. This can lead to inaccuracies in the monitoring of blood pressure and the effects of anti-hypertensive treatment. In a paper published recently in the International Journal of Clinical Practice , Alsanjari and colleagues examined trends in EDP over a 10 year period. They reported a decline in both blood pressure levels and EDP over the study period but also reported that around a quarter to a third of patients still have their BP recorded with a zero end digit. The authors conclude that blood pressure should be recorded using automated blood pressure monitoring devices to help to overcome the problem of EDP.