InnovAiT - current issue

News & Views

Etherington, C., van Hecke, O. — 2009-06-21

Knee pain

Mehrali, T. H, Yunas, I. — 2009-06-21

Knee pain is a common presenting symptom in primary care. Around 4.5 million people in the UK, over 100 patients per GP, have severe or disabling knee pain. About 25% of people over the age of 55 years complain of chronic knee pain which is usually diagnosed as osteoarthritis. At the other end of the age spectrum, knee pain affects as many as one in three teenagers and young adults at some time or other.

AKT question relating to meniscal tears

Houghton, M. — 2009-06-21

Management of shoulder pain in general practice

Murphy, R., Carr, A. — 2009-06-21

Shoulder pain is a common problem accounting for significant morbidity and disability in the community. As the third most frequent musculoskeletal problem presenting in primary care, shoulder pain has a prevalence of 16–26% in the UK population and around 1% of adults consult their GP with a new presentation of shoulder pain each year. The aetiology of shoulder pain is diverse and many disorders present with similar symptoms and signs. Patients with shoulder pain suffer from a spectrum of functional disability; they may have difficulty performing many essential activities of daily living and are often forced to take time off work.

Joint and soft tissue injections in General Practice

Saunders, S. — 2009-06-21

Musculoskeletal conditions are common, accounting for 15–20% of GP consultations, are chronic disorders and are usually managed in primary care. Injection therapy is an intervention that normally involves localized administration of a corticosteroid with a local anaesthetic. It has been in use for more than 50 years, and there is plenty of anecdotal evidence of its efficacy, but few definitive studies of its application in joint and soft tissue lesions. Despite this, it is the most common therapeutic intervention in rheumatological practice and is recommended for knee and shoulder problems in national and international guidelines. Given its relative safety, ease of application, cost-effectiveness plus the frequent lack of convincing systematic evidence for the benefit of alternative treatments, injection therapy is a useful outpatient treatment modality.

From the Trainer

Richardson, J. — 2009-06-21

Venous and arterial leg ulceration

Irving, G., Hargreaves, S. — 2009-06-21

Chronic leg ulceration is a major health problem in the UK costing the NHS up to £600 million per annum. In Western countries, 1–2% of the population is likely to have a chronic leg ulcer at any one time; this increases to 3% in those over 65 years old. Studies have found that 60–80% of chronic leg ulcers have a venous component and 10–30% are associated with arterial insufficiency. The natural history of the disease is a continuous cycle of breakdown and healing over decades. As a result, ulcer healing rates can be poor with up to 50% of venous ulcers open and unhealed for 9 months. Most of the clinical management falls to primary care with over 80% of leg ulcer cared for in the community.

Principles of heart failure

De Silva, K., Katbamna, R. — 2009-06-21

On average, a general practitioner, who works with an average practice list size of 6000 people, will look after 30 patients with chronic heart failure and suspect a new diagnosis of heart failure in approximately 10 patients annually.

AKT question relating to heart failure treatment

Houghton, M. — 2009-06-21

Abdominal aortic aneurysms

Knights, G. — 2009-06-21

Ruptured abdominal aortic aneurysms (AAAs) are uncommon and difficult to diagnose, but they are also life-threatening surgical emergencies and as such the GP should always have a low threshold for suspicion and admission. In contrast, many patients have small asymptomatic aneurysms, often diagnosed by chance during investigations for other illnesses. This article aims to look at both surveillance and treatment of the asymptomatic AAA and the emergency management of the rupturing AAA.

AKT question relating to screening for aortic aneurysms

Houghton, M. — 2009-06-21

Adult self-directed learning: setting your own agenda

Hays, R. — 2009-06-21

Medical education often uses terms like ‘adult learning’ and ‘self-directed learning’. We are told that we trained to be self-directed and adult learners from the commencement of basic medical education and that this is important if we are to remain competent over a career that may span 30–40 years. However, the ability to be an adult or self-directed learner is difficult to measure and it is therefore difficult to determine whether these processes (or are they skills?) are either innate or learnable. There is a risk that the terms are seen simply as impractical educational jargon, and so education organizations feel safest when they provide a tightly structured curriculum and assess learners through examinations based on that curriculum. The Postgraduate Medical Education Training Board has required this for all postgraduate specialties, including general practice. The obvious question then is ‘what happens next?’ as there is no such thing as a curriculum for lifelong competence. There is therefore a need for GP registrars, as part of the new RCGP curriculum, to develop the skills to be lifelong learners for two reasons. The first is to facilitate maintaining currency of practice and the second is to role model that for other learners. This paper aims to explain in simple terms how, in the context of being on the pathway to becoming an independent general practitioner, the theory can be applied to enhance adult and self-directed learning in GP registrars.

Associates in training committee--past, present and hopes for the future

Taylor, C. — 2009-06-21

Case study. A pain in the back--dealing with musculoskeletal complaints

Godeseth, C. — 2009-06-21

Crammer's Corner

Rughani, A. — 2009-06-21

AKT answer relating to meniscal tears

2009-06-21