InnovAiT: Education and inspiration for general practice

Neonatal jaundice is the most common reason for readmission to hospital in the first week of life. About 60% of term and 80% of preterm babies develop jaundice in the first week of life, and about 10% of breastfed babies are still jaundiced at 1 month of age. Mostly, neonatal jaundice is benign and does not need any intervention. However, the possibility that jaundice may be a sign of serious underlying illness warrants close consideration. This article aims to give an outline of neonatal jaundice in infants of 35 and more weeks of gestation from birth to 28 days of age, its management in primary care and indications for referral to secondary care.

Breastfeeding has many proven benefits for both mother and baby, yet in the UK, we have some of the lowest breastfeeding rates in Europe. The World Health Organization recommends exclusive breastfeeding for the first 26 weeks of life and then solid food alongside breastfeeding. In 2005, 78% of mothers in England attempted to breastfeed their babies at birth but less than 1% of UK mothers exclusively breastfed to 6 months. This article aims to provide an overview of some of the problems encountered when breastfeeding and how they can be overcome to allow continuation of feeding.

Failure to thrive is a description applied to children whose current weight or rate of weight gain are significantly below that of other children of similar age and sex. It is a common problem that is often seen in general practice. Medical and social factors may both contribute to the condition. These range from paediatric disorders such as coeliac disease to childhood neglect. Early diagnosis and intervention are important for preventing malnutrition, as well as mental, emotional and social problems in adulthood.

Breathing disorders during sleep are best described as a spectrum of disorders. Normal quiet regular breathing lies at one end of the spectrum. In between there are worsening levels of snoring with progressively increasing levels of upper airway resistance culminating in obstructive sleep apnoea/hypopnoea syndrome (OSAHS) at the most severe end of the spectrum. The prevalence of OSAHS is 1–4% in middle-aged individuals and it is suggested that it is twice as common in men compared to women.

Interstitial lung disease (ILD), previously known as diffuse parenchymal lung disease, refers to an extensive variety of acute and chronic disorders that have similar clinical and radiological features. These disorders cause inflammation or fibrosis of the alveolar and interstitium of the lung. The aim of this article is to give guidance on clinical assessment, causes and management of ILD.

Cystic fibrosis (CF) is the most common, life-limiting, inherited disease in Caucasian populations. Currently in the UK, there are approximately 8000 people with CF and 3 million healthy carriers. It is an autosomal recessively inherited condition that causes multisystem disease, particularly affecting the lungs and gastrointestinal tract. CF occurs in 1 in 2500 live births so with the advent of national newborn screening for this condition, GPs are likely to face more consultations relating to CF. The aim of this article is to give an overview of CF including its genetics, screening programme and diagnosis, clinical features, current management and future therapies.

GPs face particular challenges in relation to confidentiality for a variety of reasons. Information about one patient may be relevant to another family member who is also the GP's patient. GPs provide continuity of care for their patients not only over time but also across multiple illnesses, minor and major. They are more likely to be aware of the social dimension of their patients' lives, for example, to know if their patient with epilepsy is driving. The GP patient record is displayed on the computer screen during a patient consultation and is visible to anyone who has accompanied the patient without the patient necessarily realizing it. These and other examples illustrate why GPs need to be aware of the ethical and legal requirements governing patient confidentiality and its implications for their work in day-to-day practice. This article describes the ethical and legal framework within which health care professionals discharge their duty of confidentiality and looks at recent General Medical Council (GMC) guidance and its practical implications.

New GPs are well trained and well placed to fulfil the requirements for revalidation. However, the current job market predicted 20–30% cuts in National Health Service (NHS) spending and the rethinking of how we provide care will bring radical changes to the workplace and workforce. Doctors will need resilience, flexibility and a clear personal action plan to stay safe and thrive in the new culture of General Practice. For example, as a newly qualified doctor, you may find yourself negotiating a difficult partnership, struggling to meet clinical demands or wondering about what direction your future career path should take. This is exactly the kind of thing that mentoring can help you to navigate.