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Half pint of Half a small 1 single 1 small 1 single “regular” beer, glass of wine measure glass of measure of lager or cider of spirits sherry aperitifs ... and each of these is more than one unit 3 3 9 9 2 3 1.5 2 4 Pint of “regular” Pint of “strong” Alcopop or a 440ml can of 440ml can of 250ml glass of 75cl Bottle of beer/lager/cideror “premium” beer, 275ml bottle of“regular” larger “super wine (12%) wine (12%) lager/cider regular lager or cider strength” larger Scoring System Your score Questions 0 1 2 3 4 How often do you have a drink containing Monthly 2 - 4 times 2 - 3 times 4+ times alcohol? Never or less per month per week per week How many units of alcohol do you drink on a typical day when you are drinking? 0-2 3-4 5-6 7-9 10+ How often have you had 6 or more units Less than Daily or if female, or 8 or more if male, on a single Never Monthly Weekly almost occasion in the last year? monthly daily How often during the last year have you Daily or found that you were not able to stop Never Less than Monthly Weekly almost drinking once you had started? monthly daily How often during the last year have you Daily or failed to do what was normally expected Never Less than Monthly Weekly almost monthly from you because of your drinking? daily How often during the last year have you Daily or needed an alcoholic drink in the morning to Less than get yourself going after a heaving drinking Never monthly Monthly Weekly almost daily session? How often during the last year have you had Less than Daily or Never Monthly Weekly almost a feeling of guilt or remorse after drinking? monthly daily How often during the last year have you Daily or been unable to remember what happened Never Less than Monthly Weekly almost the night before because you had been monthly daily drinking? Yes, but Yes, Have you or somebody else been injured as a No not in the during the result of your drinking? last year last year Has a relative or friend, doctor or other Yes, but Yes, health worker been concerned about your No not in the during the drinking or suggested that you cut down? last year last yearGeneral Practice Physical Activity Questionnaire Date……………………… Name…………………….. 1. Please tell us the type and amount of physical activity involved in your work. Please mark one box only I am not in employment (e.g. retired, retired for health reasons, unemployed, a full-time carer etc.) b I spend most of my time at work sitting (such as in an office) I spend most of my time at work standing or walking. However, my work does c not require much intense physical effort (e.g. shop assistant, hairdresser, security guard, childminder, etc.) My work involves definite physical effort including handling of heavy objects d and use of tools (e.g. plumber, electrician, carpenter, cleaner, hospital nurse, gardener, postal delivery workers etc.) e My work involves vigorous physical activity including handling of very heavy objects (e.g. scaffolder, construction worker, refuse collector, etc.) 2. During the last week, how many hours did you spend on each of the following activities? Please answer whether you are in employment or not Please mark one box only on each row None Some but 1 hour but 3 hours or less than less than more 1 hour 3 hours Physical exercise such as swimming, a jogging, aerobics, football, tennis, gym workout etc. b Cycling, including cycling to work and during leisure time Walking, including walking to work, c shopping, for pleasure etc. d Housework/Childcare e Gardening/DIY 3. How would you describe your usual walking pace? Please mark one boxonly. Slow pace Steady (i.e. less than 3mph) average pace Brisk pace Fast pace (i.e. over 4mph) Hit return to calculate PAI THE NHS HEALTH CHECK AND FAMILIAL HYPERCHOLESTEROLAEMIAWhy is a diagnosis of Familial Hypercholesterolaemia (FH) important? Since monogenic FH is a single gene disorder and ‘runs in families’, 50% of the brothers and sisters and 50% of the children of your FH patient are at risk of also having FH. If the diagnosis of FH is confirmed, they can easily be offered diagnostic tests and affected individuals effectively treated with statins to reduce their subsequent risk of early onset heartdisease. What should a GP do when an individual has been identified through the NHS Health Check programme with a total cholesterol of > 7.5 mmol/L? The following steps should be carried out: • Repeat the measurement on a fasting blood sample. The laboratory can then calculate the LDL cholesterol concentration. The diagnostic cut-off for a possible diagnosis of FH in an adult is a total cholesterol of > 7.5 mmol/L but more specifically an LDL cholesterol of > 4.9mmol/L. • If on the retest the LDL is >4.9 mmol/L, exclude secondary causes of hypercholesterolaemia. These are: (a) Hypothyroidism (measure TSHlevels) (b) Renal impairment (measure creatinine) (c) Obstructive liver disease (measure liver function tests) (d) Diabetes (using a fasting blood glucose measure) – usually associated with hypertriglyceridaemia • If secondary causes of hypercholesterolaemia have been excluded, or the patient continues to have a high cholesterol despite management of the secondary cause, then the patient should be referred to a local lipid clinic. The clinic will carry out further tests and take a detailed family history for the confirmation of the diagnosis. If not confirmed, the patient will be referred back to the GP. If confirmed the clinic will, initiate intensive statin therapy and cascade testing of affected relatives. Usually once the NICE recommend lipid lowering for FH patients is achieved (target of 50% lowering of pre- treatment LDL cholesterol) the patient will be discharged back to the GP for a shared care arrangement and agreed annual review schedule as recommended by the NICE guidelines. Click here to use the Heart UK lipid clinic finder Find your nearest cholesterol specialist | HEART UK To Note: 1 The probability of an individual having FH is increased by the degree ofelevation of LDL cholesterol. While an LDL of 4.9-5.5 can be diagnostic of FH, it can also be due to “polygenic” causes. Conversely, in an individual with LDL levels over 6.0 mmol/L polygenic causes are much less likely, and a diagnosis of FH is very much more likely. 2 Individuals who report having relatives with either elevated cholesterol levels and or early heart disease are very likely to have monogenic FH and should definitely be referred. The NICE guideline suggests using the criteria for early CHD as under 55 years in a first-degree male relative and under 65 in a first-degree female relative. With Electronic Blood Pressure Monitors • The patient should be seated for at least 5 minutes, relaxed and not moving or speaking; • The arm must be supported at the level of the heart. Ensure no tight clothing constricts the arm; • Place the cuff on neatly with the centre of the bladder over the brachial artery. The bladder should encircle at least 80% of the arm (but not more than 100%); • Some monitors allow manual blood pressure setting selection where you choose the appropriate setting. Other monitors will automatically inflate and re-inflate to the next setting if required; • Repeat three times and record measurement as displayed. Initially test blood pressure in both arms and use arm with highest reading for subsequent measurement. Indication (cm)* = (cm)* = Bwidth & length (cms)* A(cm)*rc. Small Adult/Child 10 - 12 18 – 24 12 x 18 < 23 Cuff Sizes Standard Adult 12 - 13 23 – 35 12 x 26 < 33 Large Adult 12 - 16 35 – 40 12 x 40 < 50 Adult Thigh Cuff** 20 42 < 53 * The range for columns 2 and 3 are derived from recommendations from the British Hypertension society (BHS), European Hypertension Society (ESH) and the American Heart Association. Columns 4 and 5 are derived from only the NHS guidelines. =* Bladders of varying sizes are available so a range is provided for each indication (applies to columns 2 and 3). Points to note: It is good practice to occasionally check the monitor against other validated devices. It is important to have the monitor serviced and calibrated according to manufacturer’s guidelines.What needs to be done next and what do I do? What needs to be one nextNeeds to be done.? What do you need to do? Needs to be done. What do you need to ABPM/Home do? BP >140/90 mmHg & <179/119 mmHg BP/Pharmacy BP >140/90 mmHg & Check for DM & CKDe BP >180/120 mmHgmHg See duty Dr / ANPcy Check for DM & CKD See GP/ANP/PharmDr / ANP CVD Risk 20%0/120 mmHg Start a statin See GP/ANP/ harm,/Pharm CVD Risk 10-19%>20% Start a statin recommend statin CVD Risk <10%k 10-19% NHS Health Check in 5rm, ryearsend a statin CVD Risk <10% See GP, check full lipidn 5 profile, thyroid, liver, TC>7.5 mml/L kidney, diabetes. Considerlipid prFHile, thyroid, liver, TC>7.5 mml/L kidney, diabetes. Consider QDiabetes > 5.6 Check HB 1c Cambridge > 0.2 FH Leicester practice4.8 Check HBa1c Leicester risk assessment >= 16 Leicester practice > 4.8 Leicester risk assessmSee duty Dr/ANP/Pharm HbA1c >= 16 See duty Dr/ANP/Pharm HbA1c >48 Diabetes prevention HbA1c 42-48 programme Diabetes prevention HbA1c 42-48 Lifestylprogramme HbA1c 37-42 Lifestyle advice HbA1c 37-42 Lifestyle advice HbA1c <37 Lifestyle advice HbA1c <37 Weight management BMI >30 programme, Diabetes prevention programmement BMI >30 Complete rest of Audit Ces Audit C>5 prevention programme Offer advice, Drink Awareudit C Audit C>5 Audit C 8-19 app Offer advice, Drink Aware Audit C 8-19 Referral to specialist Audit C >20 alcohol services Referral to specialist Irregular pulse20 ECGcohol services Smoker Stop smoking services Irregular pulse ECG Lifestyleker Local and national serviceses Better Health https://www.healthcheck.nhs.uk/commissioners-and-providers/national-guidance/ Better Health https://www.healthcheck.nhs.uk/commissioners-and-providers/national-guidance/Useful Websites Free LWN Webinars www.learnwithnurses.org MedAll MedAll — Healthcare training for everyone. Alcohol www.drinkaware.co.uk/for-professionals/#health www.e-lfh.org.uk/programmes/alcohol www.alcoholconcern.org.uk/unit-calculator?gclid=CImZu_3KodICFecK0wodYqcLeQ Better Health (was One You) www.nhs.uk/better-health/ British Hypertension Society www.bihsoc.org (Great for validated BP monitors and info for ABPM & HBPM) Charities: www.heartuk.org.uk / Catalogue (learninghub.nhs.uk) (Great for cholesterol) * supporters of our training www.bloodpressureuk.org/Home (Great patient info and blood pressure week) www.bhf.org.uk www.diabetes.org.uk Computerised Brain Games www.stayingsharp.aarp.org/about/brain-health/games www.lumosity.com www.brainHQ.com CVD Risk Calculators www.nhs.uk/conditions/nhs-health-check/pages/check-your-heart-age-tool.aspx www.jbs3risk.com/pages/risk_calculator.htm Dementia Leaflet www.healthcheck.nhs.uk/commissioners_and_providers/training/dementia_training www.healthcheck.nhs.uk/commissioners_and_providers/marketing/dementia_resources Free e-Learning www.e-lfh.org.uk/programmes/all-our-health NHS Health Checks – template letters, posters and data & statistics www.healthcheck.nhs.uk www.healthcheck.nhs.uk/commissioners-and-providers/national-guidance/ www.healthcheck.nhs.uk/commissioners-and-providers/training/competency-framework-and-learner-and- assessor-workbooks/ Obesity www.cks.nice.org.uk/topics/obesity/diagnosis/identification-classification RCN - Accountability and Delegation www.rcn.org.uk/professional-development/accountability-and-delegation Skills for Health www.skillsforhealth.org.uk/info-hub/category/the-care-certificate/ Registered office: 2-6 Boundary Row, London, SE1 8HPTel: 0330 124 1966 www.smarthealthsolutions.co.ukNotesNotes