Diagnosis Resources

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

Hayley Plimmer lost her 64-year old mother Catherine ‘aka Kay’ Christopher to liver cancer in 2017 following a late diagnosis. Hayley said:
My mother died of liver cancer five days after receiving her diagnosis and being told by
her consultant that there was nothing that could be done. It was a horribly shocking and traumatic experience for the whole family and we’re still reeling four years later. Looking back, there were some signs which we now know to have been symptoms of cancer but we had no idea at the time.

There are many different causes of liver disease and current estimates suggest that as many as one in 10 people have problems with their liver at some time in their life (Foundation for Liver Research, 2020). Perhaps most worrying is the fact that incidence of liver disease is increasing, with the number of deaths reported to have increased by 400% since 1970 (British Liver Trust, 2020). Most liver diseases are asymptomatic early on, frequently resulting in late diagnosis, potentially leading to a higher risk of poor outcomes. Many of the well-known liver diseases are preventable and this article, which covers fatty liver disease, hepatitis A, B and C and liver cancer, hopes to raise awareness of risk factors, recognition, causes and treatment of these conditions, and give general practice nurses (GPNs) and non-medical prescribers more confidence when caring for patients with these illnesses.

Migraine is a common debilitating headache condition that affects the quality of life of those affected. Migraine costs the NHS £150 million annually, with GP visits and prescriptions accounting for most of these costs. With access to neurologists and headache specialists limited in the UK, migraine is a condition GPs and general practice nurses (GPNs) are faced with on a daily basis. Therefore, it is vital that GPNs have good knowledge of migraines. They should be able to distinguish between common primary headaches, such as tension-type headaches (TTH), and migraines to avoid misdiagnosis and inform appropriate treatment, as well as to understand when acute or preventative treatments are required. As GPNs are limited in treatments they can provide for migraine, it is important that they recognise when to refer patients to a neurologist. This article explores how nurses within the general practice can effectively manage migraine patients to improve patient quality of life and alleviate pressures on an overstretched healthcare system.

Clinicians working within primary care services tend to do so in isolation and without direct access to investigative resources. This places emphasis on the clinician’s abilities to perform a focused clinical examination and employ sound clinical decision-making processes to reach a definitive diagnosis. This article looks at the case history of a patient presenting to a GP out-of-hours service with an acute, undifferentiated illness, and explores the decisionmaking processes used by the author, a trainee advanced nurse practitioner at the time, to support a working diagnosis and justify a clinically suitable management plan.