Resources

Fungating wounds can have a devastating effect on patient quality of life. Common symptoms, such as bleeding, odour, and excessive exudate production can also cause feelings of shame for the patient, resulting in social isolation. General assessment should determine the patient’s physical, psychological and emotional status, and how the family is coping. Wound assessment is crucial to determine the extent of any symptoms, to identify concerns of the patient and family, to form a baseline against which to measure wound progress, and to identify management goals. Use of a tool such as the Triangle of Wound Assessment promotes a systemic approach to wound evaluation, helps with data collection and recording, and can help to identify treatment goals. This article outlines the key principles of the assessment and management of fungating wounds, and presents a case report describing the use of the Triangle of Wound Assessment to successfully manage a patient with a fungating wound, using a conformable, silicone foam dressing impregnated with silver.

This article, the second in a two-part series, further raises awareness of upper airway disorders, as defined by the upper airway disorders position paper from the Royal College of Speech and Language Therapists (RCSLT; Haines et al, 2021). It looks at management approaches for persistent throat symptoms, refractory chronic cough, and inducible laryngeal obstruction. These disorders are primarily related to laryngeal dysfunction, notably laryngeal-hypersensitivity. Recognising the immense time pressures within clinical practice, tables have been included that could support patients’ understanding of symptoms and help to start self-care strategies.

Occupation-related lung diseases can be defined as diseases that are caused or made worse by the work environment. These are usually as a result of long-term and repeated exposures, although a single major exposure can result in lung damage. The symptoms of occupation-related lung diseases may be similar to those of other conditions, therefore as clinicians, taking both a past and current occupational history is important to assist in determining the possibility of workrelated lung disease/damage. It should be remembered that occupational lung disease may not only affect the individual who is exposed to the cause at his/her work, but also those who are exposed to the cause in their home. A well-recognised example of this type of exposure is asbestos-related disease, where an individual may be exposed to the pollutant by contact with the worker’s clothes, for example by washing them, and may also suffer the effects of asbestos exposure. The Health and Safety at Work Act (HSW Act) published in 1974 established a foundation principal; that those who create the risk are those who should control the risk. The challenge as clinicians, is that many of the lung-related diseases identified are a consequence of exposure prior to the HSW act. This does not mean occupational exposure after the publication of the HSW Act in 1974 is safe, but it did become the basis for improving occupational health and safety. This article explores some of the recognised occupation-related lung diseases.

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.

Wound management can be challenging, with both clinicians and patients wanting to follow care pathways and treatment regimens that promote wound healing. The National Wound Care Strategy Programme (NWCSP) for lower limbs endorses the use of compression garments, such as leg ulcer hosiery kits and compression wraps, to utilise NHS resources in the most effective way, and encourages patient participation where possible (NWCSP, 2020). This article looks at the pro-active work of a general practice nurse (GPN) team in Bristol, who shared their wound care expertise with local colleagues by showcasing good practice and pathways together in a new style leg clinic.

Diabetes care in general practice is facing increased pressure to improve access for and engagement from patients to reduce long-term problems associated with poor diabetes control. Digital diabetes methods aim to bridge the gap between patient engagement and poor service delivery by improving flexibility for patients to access suitable care. Digital methods include both video and SMS services to allow patients to undertake consultations or reviews in a variety of settings. This article provides general practice nurses (GPNs) with the foundations of how digital diabetes care can be established in practice in relation to initiating and managing both oral and injectable therapy. Indeed, digital health care is the way forward for managing issues of limited staff and lack of appointments, while improving patient engagement across the board.

Developing knowledge of Covid-19 has been a very long, steep learning curve. Real-time research and people data, alongside modelling, have helped us keep ahead — for the most part. Knowledge of long Covid is even more scant and, as such, much of the evidence base for management is anecdotal. Many studies are being undertaken to further the progress of diagnosis and management of long covid, and most of these are ongoing within the long Covid treatment clinics. However, what may work for one person may be ineffective for another, and so a great deal of management is around what works best for the patient at the time. Not pushing the boundaries of comfort is a common refrain and developing an awareness of what is possible, listening to the body and acting accordingly form
the basis of management in the majority of cases.

It’s easy to worry about the things we might get wrong in our working lives and the level of consequences that could potentially follow, but what about focusing and celebrating what we get right (sometimes harder to see) and the potential for helping people achieve longer, healthier lives.