SAJDVD: VOLUME 5, ISSUE 4, NOVEMBER 2008
  1. Title: 'Time is brain' and stroke units : stroke care today : editorial
    Authors: Bryer, Alan
    From: South African Journal of Diabetes and Vascular Disease, Vol 5, Issue 4, Nov
    Published: 2008
    Pages: 151-153
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    Abstract: In 2008, stroke remains a leading cause of death and adult disability. Estimates from the Global Burden of Disease study indicate that 80% of stroke deaths occur in low- and middle-income regions of the world. All-stroke fatality from available hospital-based prospective studies in sub-Saharan Africa is about 30% at one month post stroke, which is much higher than the 20% found in considerably older populations in the rest of the world.
     
  2. Title: Management of hyperglycaemia in acute stroke : review
    Authors: Parbhoo, Thakor
    From: South African Journal of Diabetes and Vascular Disease, Vol 5, Issue 4, Nov
    Published: 2008
    Pages: 155-157
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    Abstract: Stroke or 'brain attack' is a catastrophic illness, defined as an acute disturbance of cerebral function caused by occlusion or rupture of a blood vessel supplying a specific region of the brain, and causing a neurological deficit lasting more than 24 hours or death within 24 hours.
    Stroke is a major global public health problem associated with a tremendous cost burden to society. It is the third leading cause of death and the leading cause of disability in the United States. In South Africa, stroke is the third most frequent cause of all deaths reported, and in 1990 accounted for 9.6% of all reported deaths. Similarly, of all deaths reported in the age group 25 to 64 years (the workforce), 7.45% were due to stroke. The majority of strokes are ischaemic but about 15% of strokes are caused by intracerebral or subarachnoid haemorrhage. Atherothrombosis is a progressive disease involving low-density lipoprotein (LDL) cholesterol deposition, endothelial dysfunction and inflammation, affecting both cerebral and coronary circulation.
     
  3. Title: Mending hearts and brains : the clinical case for change : policy matters
    Authors: Boyle, Roger
    From: South African Journal of Diabetes and Vascular Disease, Vol 5, Issue 4, Nov
    Published: 2008
    Pages: 159-161
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    Abstract: Over my lifetime, treatment for heart disease has improved beyond recognition. For the last six years, I have had the privilege of leading a programme that has accelerated that change, reducing waiting times, bringing in new treatments, training more specialists, and ensuring patients have more and better choices available. I am now working to repeat those strides forward for stroke, the brain's equivalent of heart attack. There are a similar number of strokes to heart attacks, but this equally devastating condition has been slower to catch the medical and public imagination in this country. With our ageing population, it represents a growing challenge for the future.
     
  4. Title: Optimising your patients' recovery after stroke : hands on
    Authors: Cox, Bev
    From: South African Journal of Diabetes and Vascular Disease, Vol 5, Issue 4, Nov
    Published: 2008
    Pages: 162-164
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    Abstract: Around 150,000 people in the UK have a stroke every year, according to the Stroke Association. Most people affected are over 65, but younger people can have a stroke. Stroke is the third most common cause of death in the UK and is also an important cause of disability, with more than 250,000 people left disabled following a stroke. The recent National Stroke Strategy for England set out a quality framework to improve stroke services. In this article, we review what we can do to help optimise outcomes for our patients who have a stroke.
     
  5. Title: You and your treatment : Asasantin® in the prevention of stroke : patient information leaflet
    Authors: Webb, Mike
    From: South African Journal of Diabetes and Vascular Disease, Vol 5, Issue 4, Nov
    Published: 2008
    Pages: 165
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    Abstract: One of the most important ways to prevent recurrence of a stroke is the use of drugs to stop platelets sticking together. Asasantin® (dipyridamole and aspirin) contains a combination of two drugs, which both prevent platelets from sticking together, and should be taken by people who have had a previous ischaemic stroke or transient ischaemic attack (ministroke), to reduce the chance of recurrence.
     
  6. Title: Warfarin for atrial fibrillation : 'faff' or lifesaver? : therapeutics review
    Authors: Cowan, Campbell; Holding, Shona; Tyndall, Keith; Graham, Adele
    From: South African Journal of Diabetes and Vascular Disease, Vol 5, Issue 4, Nov
    Published: 2008
    Pages: 167-170
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    Abstract: Improving the management and prevention of stroke is a priority for the NHS. Atrial fibrillation (AF) is widely recognised to be a major cause of stroke. Moreover, it is a preventable cause in that the increased risk of stroke associated with AF can be markedly reduced by anticoagulation with warfarin. Yet a substantial number of cases of AF remain undetected and untreated. Of more concern, even after identification of AF, many individuals at high risk of stroke do not receive warfarin.
    This article reviews the evidence on the importance of AF as a cause of stroke and assesses the benefits of anticoagulation and our reluctance to anticoagulate. Finally, it explores ways of improving on current practice, to increase the proportion of patients with AF receiving anticoagulants.
     
  7. Title: You and your treatment : starrting on warfarin : patient information leaflet
    From: South African Journal of Diabetes and Vascular Disease, Vol 5, Issue 4, Nov
    Published: 2008
    Pages: 171
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    Abstract: Some conditions such as abnormal heart rhythms (including one type of abnormal rhythm called atrial fibrillation) lead to a risk of small blood clots developing. This is because blood does not flow through the blood vessels in the heart efficiently. Warfarin 'thins' the blood a little so that the blood flow is 'smoother'.
     
  8. Title: Atrial fibrillation : giving your patients the best care : hands on
    Authors: Cox, Bev
    From: South African Journal of Diabetes and Vascular Disease, Vol 5, Issue 4, Nov
    Published: 2008
    Pages: 173-177
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    Abstract: Atrial fibrillation (AF) is a condition that we are seeing more and more in general practice, with the increasingly ageing population. It is an important risk factor for stroke - particularly in older people - making it a good candidate for primary care teams to target in efforts to prevent cardiovascular disease. In this article, we explore how to diagnose and treat, using a case study to guide us through the key issues.
     
  9. Title: Diabetes Conversations : providing patients with an interactive verbal, visual and group educational experience : diabetes educator's focus
    From: South African Journal of Diabetes and Vascular Disease, Vol 5, Issue 4, Nov
    Published: 2008
    Pages: 178, 180
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    Abstract: Diabetes care is about much more than just glycaemic control - it's about ensuring that patients live longer, healthier lives. However, educating patients about the disease with a view to ensuring this, is fraught with challenges. Michael Brown, clinical manager of the Centre for Diabetes Education in Johannesburg and a diabetes nurse educator who was trained in Europe, notes that few educators really understand counselling and that acquiring the skill requires lifelong learning. 'It's documented that people only remember 20% of what they hear and 30% of what they see. But when there is active engagement, that figure increases to 70%. It's therefore important not take an old-fashioned didactic approach, but to make the patient a partner in the learning process. Being a facilitator rather than a teacher allows the patients space to find their own way and their own answers.'
     
  10. Title: Raising community awareness makes a difference in diabetes management : diabetes personality
    Authors: Ngobeni, Gabaza
    From: South African Journal of Diabetes and Vascular Disease, Vol 5, Issue 4, Nov
    Published: 2008
    Pages: 181-182
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    Abstract: When Gauteng general practitioner Dr Gabaza Ngobeni relocated her practice from central Johannesburg to Diepkloof, Soweto, some years ago, she rapidly became aware of some major differences in her patient profiles, among them a notably high incidence of diabetes. 'The management of diabetes, as with any chronic disease, is a major challenge', she says. 'It requires a lot of time and education. The situation becomes even more complex when there are other coexisting conditions such as hypertension.'
     
  11. Title: Insulin infusion pump therapy in type 1 diabetes : clinical guidelines and recommendations by the South African Insulin Pump Advisory Board, April 2008 : current topics
    From: South African Journal of Diabetes and Vascular Disease, Vol 5, Issue 4, Nov
    Published: 2008
    Pages: 184-186
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    Abstract: Continuous subcutaneous insulin infusion (CSII) therapy using insulin infusion pumps has been used for over 20 years. Technological improvements in pump functionality, dissemination of accumulated knowledge and the desire to achieve blood glucose values as close to the normal range as possible have seen a significant increase in insulin pump use throughout the world. An increasing body of evidence supports the ability of insulin pump therapy to improve glycaemic control while reducing hypoglycaemic episodes when used in appropriately selected patients.
     
  12. Title: EASD Watch 2008 - update from Rome : summaries : current topics
    From: South African Journal of Diabetes and Vascular Disease, Vol 5, Issue 4, Nov
    Published: 2008
    Pages: 187-192
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    Abstract: EASD Watch 2008 - update from Rome : summaries.
     
  13. Title: Thirty years of UKPDS show a legacy effect of glucose lowering and significant cardiovascular benefit in type 2 diabetes : drug trends in diabetes
    From: South African Journal of Diabetes and Vascular Disease, Vol 5, Issue 4, Nov
    Published: 2008
    Pages: 193-194
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    Abstract: Newly diagnosed type 2 diabetic patients treated intensively in the UKPDS study from 1977 to 1997 and followed for a further 10 years (UKPDS 80) showed continued benefit from earlier glucose control using sulphonylurea (glibenclamide) and / or insulin.
     
  14. Title: Chronic neuropathic pain : frequently misunderstood and under-treated : drug trends in diabetes
    From: South African Journal of Diabetes and Vascular Disease, Vol 5, Issue 4, Nov
    Published: 2008
    Pages: 194
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    Abstract: Chronic neuropathic pain is an enormous issue in medicine, costing the US health system more than 150 billion dollars a year. Pain is not benign, and neuropathic pain is increasingly coming under the spotlight at international meetings. The causes are complex and varied, and include musculoskeletal, notably lower back and spinal cord injury, as well as diseases like diabetes and cancer.
     
  15. Title: Secondary stroke prevention set to benefit from PRoFESS : drug trends in diabetes
    From: South African Journal of Diabetes and Vascular Disease, Vol 5, Issue 4, Nov
    Published: 2008
    Pages: 196
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    Abstract: The first head-to-head study of two antiplatelet regimens recommended for the secondary prevention of ischaemic stroke, conducted in the PRoFESS study, demonstrate that the risks of recurrent stroke or the composite risk of stroke, myocardial infarction or vascular death are very similar with either extended-release dipyridamole (ER-DP) plus aspirin or clopidogrel in patients with non-cardioembolic ischaemic stroke.
     
  16. Title: Fenofibrate reduces risk of amputations in patients with type 2 diabetes : drug trends in diabetes
    From: South African Journal of Diabetes and Vascular Disease, Vol 5, Issue 4, Nov
    Published: 2008
    Pages: 197-198
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    Abstract: Exciting new data from the FIELD study show additional microvascular-associated benefits of fenofibrate. This is the first time in a large-scale, prospective study that a lipid-modifying therapy has been shown to significantly reduce the risk of lower-limb amputation in patients with type 2 diabetes.
     
  17. Title: Vascular and renal benefits are additive using intensive blood pressure control and incremental glucose control in type 2 diabetic patients
    Comment from attending South African experts : drug trends in diabetes
    From: South African Journal of Diabetes and Vascular Disease, Vol 5, Issue 4, Nov
    Published: 2008
    Pages: 201-202
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    Abstract: The results of the ADVANCE trial studying the effect of the interaction between the two interventions (intensive glucose lowering with modified-release gliclazide and fixed combination of perindopril and indapamide) were released at the EASD on Monday, 8 September.
     
  18. Title: Diabetes news
    From: South African Journal of Diabetes and Vascular Disease, Vol 5, Issue 4, Nov
    Published: 2008
    Pages: 203-204
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    Abstract: Simplify your life with diabetes
    Creating a better tomorrow, today
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