InnovAiT: Education and inspiration for general practice

Lumps in the neck are a common clinical finding, affecting all age groups. Neck lumps may be extremely worrying for both physician and patient, as a wide variety of pathological conditions can present with a lump in the neck. This can therefore result in difficulties in diagnosis.

A cute leukaemias are malignant disorders that arise from the clonal proliferation of a single haematopoietic stem cell. The morbidity and mortality associated with acute leukaemias are due to the effects of bone marrow failure which arises from the accumulation of abnormal blood cells in the bone marrow.

Rhesus incompatibility between mother and foetus can, if undetected and untreated, lead to Rhesus disease of the newborn: a haemolytic state which can be fatal. Screening in pregnancy allows routine prevention of Rhesus disease. Post-delivery administration of anti-D immunoglobulin to Rhesus-negative women began in the UK in 1969. As a result, the deaths attributed to RhD alloimmunization fell from 46/100 000 births before 1969 to 1.6/100000 in 1990. However, antenatal procedures and presentations commonly encountered in primary care may cause the exposure of a Rhesus-negative mother to Rhesus antigens. Awareness of Rhesus disease in routine and emergency antenatal care is therefore essential.

Coeliac disease has historically been considered a rare gastro-intestinal disorder with most clinicians expecting to recognize the overt childhood presentation of chronic diarrhoea, malabsorption and failure to thrive. In fact, it is estimated to affect 1% of the general population, often presenting in adulthood with a multitude of intestinal and extra-intestinal manifestations. It is a chronic, permanent, autoimmune condition, which if left untreated, can be potentially life threatening. The only effective treatment is complete, lifelong removal of gluten from the diet with long-term follow-up. Currently, for every adult patient diagnosed, eight cases are estimated to go undetected, indicating a failure in case finding in primary care. This article aims to improve symptom awareness of coeliac disease, highlight common pitfalls in diagnosis and management, discuss common associations and provide guidance in gluten-free prescribing.

The manifestation of gallbladder disease varies widely in terms of symptoms, clinical signs and severity. Gallstones, for example, affect 10–15% of the adult population, equating to more than 5 million people in the UK. Indeed, gallbladder calculi are the most common abdominal problem leading to hospital admission. In addition, the cholecystectomy is one of the most commonly performed surgical procedures, with 50 000 per year in the UK. This article aims to summarize gallbladder diseases including congenital gallbladder disorders, gallbladder calculi, their sequelae and gallbladder cancer.

People in Western populations have a 1 in 10 lifetime risk of developing peptic ulcer disease. Although recent decades have seen major advances in our knowledge and treatment of peptic ulcers, symptoms and complications from peptic ulcers remain a significant problem for primary and secondary care practitioners. Primary care practitioners have a central role in the prevention, recognition and treatment of peptic ulcers. This article summarizes the causes, presentations, investigation and current treatment of peptic ulcer disease.

The ability to teach as a doctor in general practice (GP) is not only a requirement for the GP curriculum but is increasingly being recognized as a key skill for any doctor in the modern National Health Service (NHS). The recent guidance document from the General Medical Council, ‘Duties of a doctor’ clearly states: ‘Teaching, training, appraising and assessing doctors and students are important for the care of patients now and in the future. You should be willing to contribute to these activities’. Long gone are the days when doctors were expected to know all they needed to know simply because they were doctors. New models of working and the drive for all new alternative providers of medical services practices to offer training mean that the ability to teach is also an attractive skill for you to offer to future employers. The types of people involved in teaching and learning in primary care are now more diverse than ever before. Working in a multidisciplinary team with other colleagues brings unique challenges that could see you feeling out of your comfort zone. This article will help you to feel more prepared to teach others, using the example of teaching about asthma.