Diagnosis Resources

Due to its diverse manifestations, Lyme disease (caused by the bacterium Borrelia burgdorferi) can present as a diagnostic challenge. This article will help practitioners to recognise Lyme disease in all its formats, ensure that historytaking and assessment are appropriate, and to consider other differentials while considering Lyme disease as the most likely diagnosis. Additionally, clinicians need to be able to manage the presentation appropriately using up-to-date guidelines. There will also be some discussion about the sequelae of Lyme disease — treated or untreated — and the impact of global warming on arthropod disease generally, including Lyme disease.

An awareness of the impact of climate change has led to policies to reduce greenhouse gas emissions (GHGEs). The National Health Service (NHS) is the UK public sector’s largest emitter of greenhouse gases, with a target to deliver a net zero NHS by 2050 (NHS, 2020). Pressurised metered dose inhalers (pMDIs), which use hydrofluoroalkanes (HFA) as the propellant, have been targeted as a perceived easy option to reduce the NHS carbon footprint of HFA, as alternative inhaler devices in the form of dry powder inhalers (DPIs) and soft mist inhalers (SMIs) which contain no propellant are readily available. Balancing the environmental impact while ensuring that the best option of inhaler device is provided for individual patients can lead to conflict and confusion for healthcare professionals while waiting for manufacturers to provide pMDI with propellants that are more environmentally friendly. This article discusses sustainability, from manufacture to disposal.

Heart failure (HF) remains one of the most common reasons for hospital admissions and is predicted to rise substantially in the next decade. As many of these patients have other comorbidities, general practice nurses (GPNs) are in the ideal position to assess and identify any possible deterioration before it results in admission. Having a good understanding of HF, terminology and treatment will assist with this, and standardising care and reviews in line with current guidelines will improve care.

For many nurses working in general practice, chronic obstructive pulmonary disease (COPD) is a familiar condition. From carrying out annual reviews to supporting people living with the symptoms of cough, phlegm, breathlessness and managing their effect on day-to-day living, most general practice nurses (GPNs) will have some experience of supporting people living with COPD. Increasingly, though, GPNs are having to consider comorbidities as part of the review, as for many people living with COPD, this will be just one of the long-term conditions they have already been diagnosed with or of which they will be at risk. In this article, the relationship between COPD and other long-term conditions will be highlighted, along with recommendations about how to identify and manage comorbidities in order to holistically optimise outcomes.

Heart failure (HF) is a complex clinical syndrome which arises when the heart is unable to pump blood adequately around the body, leading to a range of symptoms from shortness of breath and fatigue to fluid retention. HF care is complex, multifaceted, and is often delivered in varied settings by a range of healthcare workers depending on
local resources and services. To this end, the British Society for Heart Failure (BSH), using Delphi methodology (Barrett and Heale, 2020), has collaborated with cardiologists, specialist nurses, pharmacists, leads from primary and secondary care, as well as those from the wider multidisciplinary team (MDT), to develop an online resource with the aim of supporting this complex management, clinician competence and confidence, and increasing guideline-directed care. This article encourages use of this pathway and raises the importance of HF management from detection to palliative care (Karauzum et al, 2018).

Tracheomalacia, bronchomalacia and laryngomalacia are conditions where there is a deficiency in the functioning of the cartilage in the airway walls, which causes them to be weaker or even absent in places. This leads to an exaggerated luminal narrowing within the affected airway during expiration. The malacia may be localised or generalised. There is limited literature and published research in this area. These three conditions are seen in both children and adults. However, because of the size of the airways in small children and the more marked clinical response to any narrowing of the airway, these malacias are usually diagnosed at an earlier stage than when the conditions occur in adults. In the fully mature airway, the symptoms may be less obvious, leading to the conditions
being under-recognised and under-diagnosed in adults. It is also important to understand that in the adult population malacia may coexist with more common conditions such as asthma or chronic obstructive pulmonary disease (COPD), where breathlessness, cough, dyspnoea and other symptoms may be misattributed to these more common diseases.
This article raises awareness of these three malacia conditions.

The national care bundle for children with asthma is the first phase of a national plan to improve asthma care, focusing on integration of systems and effective communication. It follows several high-profile reports, national and global guidelines, with the aim of training clinicians to consistent standards, keeping children and young people (CYP) with asthma well, improving diagnosis, patient pathways and encouraging self-management. This article, the second in a two-part series, explores practical ways to implement the bundle in clinical practice and how to meet its requirements.

This article introduces the NHS England national care bundle for children with asthma, the main themes, and what is expected of clinicians in primary care. This is the first phase of a national plan to improve asthma care, with a focus on integration of systems and effective communication. It follows several high-profile reports, national and global guidelines, with the aim of training clinicians to consistent standards, keeping children and young people with asthma well, improving diagnosis, patient pathways and encouraging self-management. It explores the main themes of the asthma care bundle, and what it means for clinicians across the spheres from primary through to tertiary specialist care.

Endometriosis is a disease which presents with a number of signs and symptoms, often confusing clinicians who may easily mistake them for other conditions with similar symptoms. Diagnosis is therefore often confirmed a number of years after the initial onset of symptoms, resulting in reduced quality of life, particularly for those whose symptoms are severe. This article hopes to raise awareness among general practice nurses (GPNs) and non-medical prescribers, enabling them to suspect the condition and hopefully give women the opportunity to get their condition diagnosed at an earlier stage with subsequent earlier intervention and improved health and wellbeing in those affected by this unpleasant condition.

When patients present with red lower legs, the cause is often assumed to be cellulitis or erysipelas. There are, however, several alternative conditions which mimic the clinical signs of cellulitis or erysipelas, which can lead to misdiagnosis. It is important that the cause is correctly diagnosed to prevent inappropriate prescribing of antibiotics. This article discusses the different potential causes of ‘red legs’, in addition to cellulitis and erysipelas, together with clinical signs and symptoms to enable general practice nurses (GPNs) to differentiate between them and implement appropriate treatments