Implementing an Innovative Lipid Management Technique Using siRNA LDL-C Lowering Therapy: Lessons Learned in an NHS Primary Care Practice With Worked Case Examples.

INTRODUCTION: The UK Government partnered with industry to tackle cardiovascular disease (CVD) in the first NHS population health agreement. The ambition was to prevent 150 000 strokes, heart attacks and dementia cases over the next 10 years with a new siRNA LDL-C lowering therapy (Inclisiran) delivered within Integrated Care Services by primary care to support a comprehensive approach to lipid management. Following the approval of inclisiran, and guidance published by the National Institute for Health & Care Excellence (NICE) on its use, this paper has been created by a UK general practice to share real-world observations of cases and the potential service benefits of rolling out this innovative drug treatment. The process of identifying patients at risk of atherosclerotic cardiovascular disease (ASCVD) and lessons learned from implementing in practice is also addressed. Workstreams were developed to rapidly roll out a low clinical burden enhanced lipid management program incorporating siRNA LDL-C lowering therapy into primary care practice. APPROACH/METHOD: (1) Multi-disciplinary team (MDT) education program based on freely available Academic Health Science Network (AHSN), National Institute for Health & Care Excellence (NICE), and commercial materials. (2) Automated searches using a software program were run to identify "at-risk" patients alongside manual case-finding in everyday clinics. (3) Patients were invited for review using multi-channel modalities. (4) Where appropriate, treatment was commenced after consent was obtained. (5) Automated recall systems are used to ensure follow-up; initially at 3 months, then every 6 months. DISCUSSION AND CONCLUSIONS: Enhanced lipid management as a secondary prevention measure is achievable in line with national guidance and objectives. The methodology and education/training processes used in combination with reconstructing the management process can help practice staff realize the program benefits, which in turn can lead to a shift in behavior where all staff embed manual case-finding of high-risk patients into everyday consultations and reviews; enabling rapid identification of eligible patients. Taking a multi-disciplinary, holistic approach to new initiatives reduces service burden, particularly for GPs. Leveraging resources from the AHSN and others removes additional training pressures often associated with new initiatives and provides a wealth of educational material to support primary care MDT upskilling.

The Translation of Movement From the Equine to Rider With Relevance for Hippotherapy.

Although horseback riding is a well-established means of rehabilitation therapy for a variety of human patients, there are few data on the biomechanical relationships between horse and rider during such hippotherapy. We simultaneously tracked the movements of a horse with several different novice riders, under conditions similar to hippotherapy, to evaluate whether horses pass the same motion to different riders while being lead at a walk. Riders were outfitted with a goniometric data collection system that recorded the angles of flexion and extension and lateral bending of the thoracic and lumbar spine, as well as the flexion, extension, abduction, and adduction of each hip. We found consistent rhythmic motion in the horse's hock, shoulder, and knee. There were no significant differences in equine movement across six different riders, supporting the conclusion that horses can be used as a reproducible rehabilitation platform for riders. Moreover, although riders demonstrated different baseline postures, there were no significant differences in their ranges of motion in each joint. These results indicate that a horse can reproducibly influence a population of participants in a hippotherapy situation.