InnovAiT: Education and inspiration for general practice

There are a number of common oral problems (COPs) that patients may consult their GP about. Some patients are concerned about the appearance of structures within their mouth that are manifestations or variants of normal anatomical structures and only require reassurance. The majority of oral mucosal conditions are benign and do not represent any sinister pathology or an underlying systemic condition. This article describes the clinical presentation of some common oral lesions and conditions. Guidance is given concerning their management and when referral to an oral specialist is required. Recurrent mouth ulcers are the subject of another article in this journal.

Recurrent ulceration of the mouth is a common complaint of patients attending their GP with an oral problem. The majority will have recurrent aphthae, also known as recurrent aphthous stomatitis. This is a painful condition that can significantly affect a patient's quality of life by interfering with eating and speaking. There are a number of other causes of recurrent oral ulceration that are less common but need to be considered by the GP. This article describes the management of patients complaining of recurrent mouth ulcers and provides guidance concerning referral to secondary care.

Patients frequently present to their GP complaining of soreness or ulceration inside their mouth. Some will have noticed signs such as white or red patches; others will be concerned they may have mouth cancer. The majority of lesions that appear on the oral mucosa are benign; however, oral cancer or potentially malignant lesions may present with a similar clinical appearance and therefore a high level of suspicion is required. Late diagnosis of oral cancer results in a lower survival rate and a compromised functional and cosmetic outcome. Early detection and referral of any suspicious oral lesions are therefore essential to improve the outcome following treatment. This article describes the clinical presentation of malignant and potentially malignant oral lesions and reinforces National Institute for Health and Clinical Excellence (NICE) guidelines concerning specialist referral.

Urinary incontinence (UI) is a common and important problem, which impacts on the physical, psychological and social well-being of sufferers as well as their families and carers. Most patients with UI can be assessed and managed by GPs without the need for referral to secondary care.

Bladder cancer is the seventh most common cancer in the UK. Survival rates for this disease are favourable, with approximately 60–70% of patients surviving 5 years. This long survival rate means that many GPs will encounter patients being treated for this malignancy. This article provides an overview of the disease and its various treatment modalities.

Chronic kidney disease (CKD) is a term that describes any form of chronic kidney damage and also the circumstance where a patient's estimated glomerular filtration rate (eGFR) is less than 60 ml/min/1.73 m². The aims of this article are to explain this definition, including its limitations, describe the epidemiology of CKD and discuss the pros and cons of labelling patients as having CKD.

Assessing patients clinically through taking the history and performing a physical examination provides the basis for safe and effective clinical practice. Doctors new to general practice can find it difficult to undertake an effective clinical assessment in under 10 minutes, while not missing serious illness. This article outlines strategies for assessing patients in a focused yet patient-centred way and discusses areas that can be particularly difficult.