InnovAiT: Education and inspiration for general practice

Menstrual problems are a common experience for most women and the majority of women suffering with menorrhagia can be managed in primary care. The GP curriculum requires GP trainees to have a solid knowledge base on common menstrual disorders. It is essential to be able to differentiate a history consistent with benign menstrual disorders, like fibroids or dysfunctional uterine bleeding, and symptoms which may suggest more significant pathology such as malignancy. GPs should know how to examine and investigate patients with menorrhagia and treat appropriately. This article summarizes examination, investigation and management.

Polycystic ovarian syndrome (PCOS) was first recognized by Drs Stein and Leventhal in 1935. It is a common but poorly understood complex endocrine disorder clinically associated with infertility, hyperandrogenism and oligomenorrhoea. The UK prevalence is around 6–7%. 20% of women in the UK have polycystic ovaries on ultrasound without clinical features of PCOS and of those attending infertility clinics with anovulation, 90% have features of PCOS. It is therefore important for a GP to be able to recognize PCOS and approach treatment holistically as the condition has implications for a woman's menstrual and reproductive life, physical appearance and long-term health.

Infertility affects one in seven couples in the western world and this figure may rise as more women are delaying parenthood. It is a major cause of psychological and marital stress and, hence, deserves to be managed as a disease entity along with more traditionally recognized diseases. This article deals with the causes of both male and female infertility, initial assessment and investigations for the couple along with general advice to help them conceive in the primary care. Further assessment and investigations should be undertaken in a dedicated infertility clinic either at secondary or tertiary level.

Head lice infestation results from colonization of hairy skin by Pediculus capitis, a wingless blood-feeding parasite of the order Phthiraptera. Head lice remain a significant problem as they may cause intense pruritus, and infestation is socially and psychologically stigmatizing. The prevalence of infestations has been increasing and is higher in children aged 4–11 years, in parents of young children and in urban areas. This possibly results from an increase in social mixing and movement around the country. Over a third of children in the United Kingdom will host head lice during any year and surveys show that one to two of every 10 children have head lice at any one point in time. This article aims to provide an overview of head lice infestation and its management in primary care.

Enuresis is defined as the uncontrolled or involuntary passage of urine by day, by night or both, in a child aged 5 years or older, in the absence of physical disease. The most common form is nocturnal enuresis or bedwetting. This is a lack of night-time bladder control and accounts for 85% of people with enuresis. Daytime enuresis is rarer but is important to identify as the causes and management can differ. This article aims to provide an overview of enuresis and its management in primary care.

Persistent crying at the start of life is a common problem and has been reported by approximately 20% of parents. In most cases, no organic cause is found, and crying improves by around 3–4 months. This article will describe the causes and management of persistent crying, or ‘colic’, in the first 3 months of life.

This is the fourth paper in a series of five describing the use of evidence to support decisions made in clinical practice. The series covers large elements of statement 2: The general practice consultation, statement 3.5: Evidence-based practice of the GP curriculum.

Ongoing monitoring by a practice of its standard of care and willingness to make changes is a fundamental part of good practice. One method of doing this is through audit.