Diagnosis Resources

Polymyalgia rheumatica (PMR) is a common inflammatory rheumatic disease in older people. Three-quarters of people with PMR are women and individuals living in the south of England are at highest risk (Partington et al, 2018). Research indicates that around 17,244 people in England are diagnosed with PMR annually (Saha et al, 2023). This article aims to support general practice nurses (GPNs) in early recognition and diagnosis of PMR, effective treatment and prevention of complications such as blindness. It also focuses on preserving patient mobility and independence and minimising the risks associated with long-term corticosteroid treatment.

Hypothyroidism is a common endocrine condition characterised by an underactive thyroid gland, resulting in a deficiency of thyroid hormones. It presents with variable symptoms, which can range from mild such as fatigue and dry skin, to more severe, such as shortness of breath. As it shares fairly wide ranging symptoms with many other common conditions, such as depression, menopause, etc, it can sometimes be missed. If left untreated, the outcome can be fatal. The condition is often diagnosed and treated in the primary care setting, and this article gives nurses and nonmedical prescribers an overview of the disease with the aim of helping them recognise and treat this condition, so as to improve outcomes and quality of life.

Anaemia is a common condition occurring worldwide. There are several different forms of anaemia, with iron deficiency anaemia (IDA) and anaemia of chronic disease (ACD) being two of the most prevalent types. Both have similar symptoms but are associated with different causes. Differentiating between the two types and confirming the diagnosis can be a difficult process. This article gives an insight into these two diseases, providing nurses and nonmedical prescribers with an understanding of assessment, diagnosis and treatment.

Urinary tract infection (UTI) is a term that describes an infection anywhere within the urinary system where the commonest cause is Escherichia coli, which accounts for 80% of infections and is usually found in the urinary tract (Vasudevan, 2014). Women are more susceptible to UTIs than men as their urethra is shorter, which means that infection can easily ascend the tract (Vasudevan, 2014; John et al, 2016). However, as men age, the risk becomes equal to women (Harrington and Hooton, 2000; Rowe et al, 2014) and accurate diagnosis and management of UTIs in men using guidelines is poor (Isberg et al, 2024). This article considers the risk factors for UTI in men, how they present, and how UTI can be managed in primary care.

Childhood constipation is a common and often distressing condition affecting both the child and their family. It is frequently encountered in primary care settings and, if not managed effectively, can lead to significant physical and psychological morbidity. Effective management hinges on a comprehensive approach that encompasses assessment, diagnosis, treatment, and understanding the psychological impacts. This article covers the critical aspects of assessing and diagnosing childhood constipation, including abdominal examination, recognising red flags and differential diagnoses, further investigations, and the psychological implications of the condition. It also delves into the causal reasons for childhood constipation, its effects on the child’s well-being, parental frustrations due to poor management, and treatment options available.

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).