InnovAiT: Education and inspiration for general practice

Cardiovascular disease (CVD) is a spectrum of disorders that includes stroke, coronary heart disease (CHD) and peripheral vascular disease (PVD). CVD is the UK's biggest cause of death, with over 191 000 deaths a year. The extent to which CVD affects the health of the population and the financial burden this places on the National Health Service (NHS) makes it an important modifiable disease. Preventing CVD is now a significant role of the general practice team.

The accurate diagnosis of hypertension is a difficult issue. The 2006 National Institute for Health and Clinical Excellence (NICE) guidance for the management of hypertension in adults in primary care recommended the use of clinic measurements taken on multiple occasions. However, this process was both protracted and potentially inaccurate. As a result, some patients may have been inappropriately treated with anti-hypertensive drugs causing both unnecessary side effects and excess costs to the National Health Service (NHS). Others may not have been treated at all resulting in additional cardiovascular events. Given this, NICE has recently updated its guidance in this area to include an increasing role for ‘out-of-office’ techniques, including ambulatory and home monitoring.

Bradycardia has been defined historically as a heart rate below 60 beats/minute (bpm). However, many healthy individuals have a resting heart rate below this and some groups (such as endurance athletes) may have a resting heart rate of less than 30 bpm. For this reason, a strict lower limit is probably not useful and clinicians should use the presence of symptoms as a guide to whether bradycardia warrants further investigation. The key role of the GP is in differentiating patients with pathological bradycardia, who need further investigation or referral, from those with physiological bradycardia who do not.

Rhinitis is an inflammatory condition of the nasal mucosa which causes nasal discharge, itching, sneezing, nasal stuffiness, congestion and blockage. Rhinitis can be due to a variety of causes and is classified as allergic, nonallergic and infective. This article focuses on the diagnosis and management of rhinitis with an allergic aetiology.

An estimated 50 000 patients in the UK are referred annually to ear, nose and throat (ENT) specialist services with hoarseness of voice. Dysphonia describes any alteration to the voice, with hoarseness referring to a deeper and slightly harsher quality to the sound. Any change in the voice can indicate a number of different pathologies both within the larynx and beyond. Many causes will be benign but malignancy should always be considered. This article summarizes the management of patients presenting with hoarseness in primary care.

The salivary glands act to produce and secrete saliva. They are grouped into the minor salivary glands (located throughout the mucosa of the mouth and throat) and the paired major salivary glands: the parotid, submandibular and sublingual glands. Salivary gland tumours, both benign and malignant, can arise from any of these glands but it is the parotid, which is the most commonly affected, representing around 70% of all salivary gland tumours.

The principle of evidence-based medicine is a key focus of the GP curriculum. To understand the current evidence and clearly explain it to patients requires knowledge of basic epidemiology. Such skills are particularly important in view of the ongoing National Health Service (NHS) reforms that require all GPs to take on a greater responsibility for Public Health in their Communities. Furthermore, some GPs will be actively involved in Clinical Commissioning Groups, for whom these principles will be fundamental to delivering effective services to local populations. This article will define the key statistical terms in the GP curriculum and frame them in the context of disease surveillance and discussions with patients about diagnostic tests and treatment decisions.