InnovAiT - recent issues

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

News & Views

Etherington, C., van Hecke, O. — 2009-06-10

Fungal infections

Ali, N. — 2009-06-10

Fungi are a common cause of skin infections. The pathogens involved are usually dermatophytes and yeasts. This article covers the common types of fungal infections and provides information on how they can be recognized and managed in a primary care setting. Providing patients with advice on the preventative measures that can be taken is essential to prevent recurrent infections.

Contact dermatitis

Verma, V., Shah, S. — 2009-06-10

Approximately 15% of GP consultations in the UK are for a skin condition. In the general population, about 4.5% of people have a contact allergy to nickel and 1–3% to an ingredient in cosmetics. Studies suggest that skin disorders (29%) are the second most common cause of occupational disease after musculoskeletal conditions (57%).

AKT question relating to hand dermatitis

Houghton, M. — 2009-06-10

Benign skin tumours

Mirza, S. — 2009-06-10

Skin disorders are a common presentation in primary care accounting for up to 10% of GP consultations. Benign skin tumours make up a significant proportion of these, thus the ability to accurately assess and diagnose them and manage lesions appropriately is an essential competence in primary care.

AKT question relating to pigmented lesions

Houghton, M. — 2009-06-10

From the Trainer

Richardson, J. — 2009-06-10

Recognizing psychological distress in the consultation

Howe, A. — 2009-06-10

The new MRCGP curriculum devotes a whole section to the care of people with mental health problems—and rightly so, for up to 30% of us will have some kind of significant episode of psychological disturbance in our lifetimes. Far more of us suffer transient but problematic psychological distress, especially when we or others for whom we care are unwell. So the GP registrar doing a routine clinic in UK general practice will find that as many as one in four of their patients are experiencing psychological symptoms, with higher rates in the elderly. Previous articles have covered the specific tasks of performing mental health assessments and diagnosing depression: this article aims to review the broader context of psychological distress in the consultation. It pays additional attention to factors associated with psychological distress to which GPs and other primary care staff should be alert and to ways of addressing these in a sophisticated and humane manner. Finally, I address the question of self-management—that is minimizing the ‘human sponge’ effect often incurred by empathic GPs at the start of training.

AKT question relating to the doctor-patient relationship

Houghton, M. — 2009-06-10

Obsessive-compulsive disorder

Taylor, C. — 2009-06-10

Obsessive–compulsive disorder is a common psychiatric disorder characterized by intrusive thoughts or ‘obsessions’, which predispose to repetitive acts or rituals, known as ‘compulsions’. These compulsions are necessary to relieve the anxiety caused by the obsession. Patients have insight into the unnecessary nature of the symptoms but can find them hard to suppress. Inability to carry out everyday activities can lead to significant functional impairment. Many feel embarrassed and go to great lengths to conceal the disorder from others which can lead to a delay in diagnosis and management.

Psychosis in primary care

Cohen, A. — 2009-06-10

This paper describes the role of primary care clinicians in the management of people with psychosis. The paper uses the term ‘psychosis’ in the same way that severe mental illness is used in the Quality and Outcome Framework to mean those people who suffer from schizophrenia or bipolar disorder. The paper will cover some epidemiological characteristics of psychosis, features of people with acute psychosis, features of chronic psychosis and finally describe briefly changes to the Mental Health Act 2007 and the potential for these changes to affect the practice of medicine in primary care.

Goodbye to gobbledegook: an introduction to basic statistics in primary care

Irving, G. — 2009-06-10

‘Smoking cigarettes causes lung cancer’. This may now seem like a somewhat uninteresting fact because it is such common knowledge, yet 60 years ago relatively few people were aware of this. It has only been with the aid of research methods and statistical techniques that such a consequence of smoking was introduced to society and is now well accepted. Such trends towards evidence-based medicine can only flourish in a culture of statistical literacy. Moreover, how can we even start to effectively critically analyse a scientific paper if we do not understand the basic statistical techniques the researcher has adopted? Part of the perceived complexity with this process is a (natural) fear of statistics and consequent lack of understanding of statistical processes. To obtain a functional level of statistical literacy, one must understand the vocabulary of statistical terms, statistical methods and the effect of statistics on study design.

Crammer's corner

Rughani, A. — 2009-06-10

A view point

Neighbour, R. — 2009-06-10

Name of book: When Nietzsche Wept: A Novel of Obsession

Gubert, E. — 2009-06-10

AKT answer relating to hand dermatitis

2009-06-10

News & Views

Etherington, C., van Hecke, O. — 2009-05-21

Rashes in pregnancy

Alsop, R. — 2009-05-21

The hormonal, physiological and physical changes that occur during pregnancy can lead to a number of skin conditions being exacerbated, occurring for the first time or appearing in an altered form. In addition to this, there are a number of systemic infections in which skin symptoms or rash may be the presenting complaint. It is important to be able to distinguish between those rashes which represent potential complications for the pregnant woman and developing foetus and those which do not. Where the diagnosis is unclear, it is useful to have a management strategy to exclude serious causes.

Bleeding in early pregnancy

Rawal, N., Farquharson, R., Topping, J., Simon, C. — 2009-05-21

Bleeding in pregnancy up to 14 weeks of gestation is common, affecting as many as one in four pregnancies. GPs are expected to distinguish between those women who can be managed at home and those requiring admission.

AKT question relating to bleeding in early pregnancy

Houghton, M. — 2009-05-21

Pre-eclampsia

Seepana, S., Allamsetty, S., Simon, C. — 2009-05-21

Pre-eclampsia is a multisystem syndrome of unknown aetiology peculiar to pregnancy. Between 2003–5, the report on confidential enquiries into maternal and child health (CEMACH) recorded 18 deaths in the UK as a result of pre-eclampsia or eclampsia (0.85 per 100 000 maternities), making this the second leading cause of maternal death. In 72% of these cases, care was deemed substandard.

AKT question relating to hypertension in pregnancy

Houghton, M. — 2009-05-21

Obstetric emergencies during labour

Garland, M. — 2009-05-21

It is not every day that a GP is faced with an obstetric emergency, but in the event that you are it is essential to know what to do in these cases for the safe management of the situation. There are many complications that can occur during pregnancy and this article focuses on the management of obstetric emergencies during labour.

AKT question relating to post-partum haemorrhage

Houghton, M. — 2009-05-21

From the Trainer

Richardson, J. — 2009-05-21

Gastro-intestinal bleeding

Mehta, C., Chang, J. — 2009-05-21

Acute gastro-intestinal (GI) bleeding is defined as bleeding into the GI tract. GI bleeding is a common medical problem that can vary in presentation from being an insidious chronic blood loss to being potentially life threatening. Although 80% of acute GI bleeds stop spontaneously, it is essential to determine the source of bleeding and establish a diagnosis in order to attempt to prevent a recurrence and so that the most appropriate management may be given in future episodes. Also, an accurate diagnosis will allow a patient to be treated optimally for the underlying condition.

AKT question relating to gastro-intestinal haemorrhage

Houghton, M. — 2009-05-21

Acute breathlessness in adults

Zuberi, T., Simon, C. — 2009-05-21

Dyspnoea is the subjective sensation of breathlessness that is excessive for any given level of physical activity. Acute breathlessness is defined as severe dyspnoea evolving rapidly over minutes to hours. The sudden development of dyspnoea heralds, in most cases, a significant cardiopulmonary insult. The aim of this article is to give GPs in training a strategy to deal with acute breathlessness in primary care.

The role of the GP within the practice management structure

Morton, A., Simon, C. — 2009-05-21

There are now many different models of primary care operating within the UK. However, the traditional practice owned and run by GPs, almost always with the assistance of a practice manager, is still the most usual model of primary care provision. In some cases, the practice manager is also a stakeholder in the business, in others simply an employee. This section focuses on the management roles of the GPs within traditional style practices.

Pregnancy matters

Rasanesan, M. — 2009-05-21

Crammer's Corner

Rughani, A. — 2009-05-21

AKT answer relating to bleeding in early pregnancy

2009-05-21