InnovAiT: Education and inspiration for general practice

Rhinitis describes inflammation of the nasal mucosa. Clinically, it presents with symptoms of nasal discharge, itching, sneezing and nasal blockage or congestion. Rhinitis is a very common condition, affecting more than one in five of the UK population on an ongoing basis, and can be classified into allergic, non-allergic and infective types. Infective causes of rhinitis include bacteria and viruses, such as the common cold. They are not considered further here.

Four people per day, or one person every 7 hours, die from asthma. In 2005, asthma caused the deaths of 1318 individuals in the UK and 27 of those deaths were children. Delay in appropriate management can be fatal. Factors leading to poor outcome include doctors failing to assess severity by objective measurement, patients or relatives failing to appreciate severity and underuse of corticosteroids. It is estimated that 75% of hospital admissions and 90% of asthma deaths are preventable. It is essential that GPs know how to manage acute asthma and regard each emergency asthma consultation as acute, severe asthma until proven otherwise.

The term eczema comes from the Greek meaning ‘to boil over’. Atopic eczema affects 15–20% of schoolchildren. It usually starts under the age of 6 months and by 1 year of age, 60% of those likely to develop eczema will have done so. It is an important condition as it has considerable impact on the quality of life of affected children. Atopic eczema is associated with other atopic conditions such as asthma and hay fever. In young children, atopic eczema may be associated with food allergy. Remission occurs by 15 years of age in 75% (Fig. 1), although some children develop worsening symptoms in their teenage years and others relapse later in adulthood.

‘First do no harm’ is a basic principle of the medical profession, believed to be handed down to us by Hippocrates. Yet, every doctor has personal experience of patients who have come to harm while receiving care. We are all familiar with stories of hospital-acquired infection, such as MRSA or Clostridium difficile and with horror stories like those about patients who have had the wrong kidney removed. But do we, as doctors, really have any idea of the extent to which things go wrong in health care and the numbers of patients who come to harm?

Acute lower back pain is defined as back pain between the costal margins and the inferior gluteal folds. It is a common and important problem in primary care. The lifetime prevalence for acute low back pain lasting less than 6 weeks is 58% and, in a survey in 1998, 40% of adults said that they had experienced an episode of back pain lasting longer than 24 hours last year. At 6 weeks, 90% of patients are symptom free Department for Work and Pensions. Chronic low back pain lasts over 3 months; if it persists over 12 months, the prognosis worsens significantly. With each new presentation, it is important to assess how the patient has been affected so far by the pain, work together to speed recovery, keep alert to possible serious or sinister causes of back pain, pick up those patients with nerve root pain and identify which patients would benefit from referral onto secondary care.

Osteoarthritis (OA) is the most common type of arthritis and a leading cause of locomotor disability. Over 4.4 million people in the United Kingdom have moderate to severe OA. It is a chronic disease that causes a significant burden to society and healthcare resources and its impact is likely to increase with an ageing population and rising levels of obesity.

Although most people who injure themselves receive treatment at Accident & Emergency (A&E) or a Minor Injuries Unit, presentation of minor injuries to general practice, either to the GP directly or via the practice nurse, is a common occurrence. There are several reasons for this. Often patients have to wait a long time in A&E and presentation to the GP may save them time; it may be more convenient to go to the GP surgery rather than the A&E department if the A&E department is a long way away or the patient has difficulties with transport. Some patients may just prefer to see a doctor that they know and trust. In addition, many A&E departments give advice that injuries more than 2 days old should be presented to the GP rather than an A&E department. It is essential that GPs have a thorough knowledge of how to best manage these patients.

Each month, Crammer's Corner features information and practical advice to help you learn the core knowledge and skills described in the RCGP curriculum and prepare for the new MRCGP assessments.