Resources

Deprescribing and treatment alternatives in type 2 diabetes care can prove difficult in current practice due to increased patient demand and complexity. Both independent nurse prescribers and non-prescribers are often at the forefront in deciding treatment for patients with diabetes, and while guidance is available on how to initiate therapy, there is little on how and when to consider alternatives or even deprescribing. This article provides practice points and questions that general practice nurses (GPNs) can consider in the consultation process. Clinical judgement should be used throughout the process and individualised care is crucial to reducing, stopping or changing medication successfully for patients with diabetes. Through utilising the evidence, GPNs can initiate appropriate changes to patient treatment plans to optimise and promote standards of care.

Keeping clear and accurate patient records is key to safe and effective practice (Nursing and Midwifery Council [NMC], 2018). In wound management, systematic and timely wound assessment can lead to correct diagnosis, the implementation of clinically effective treatments and subsequent improvement in patient and wound-related outcomes (Atkin and Critchley, 2017). Updating records at every subsequent reassessment can ensure continuity of care between healthcare professionals. This article examines the importance, requirements and barriers to documentation in wound care, how ongoing comprehensive holistic assessment contributes to keeping records up to date and relevant, and looks at the increased use of digital photography in a virtual setting.

None of the 13 million of us in the UK who watched the final of ‘Strictly Come Dancing’ 2020 will need convincing of the joy of dance and dancing with others — nor of the endurance, strength, flexibility and balance required. But, have you ever considered how dance can be used therapeutically? This article presents evidence and practice about the use of dance in chronic disease management, in particular, its role in alleviating breathlessness. One of the main causes of breathlessness is chronic obstructive pulmonary disease (COPD). Pulmonary rehabilitation (PR) is an effective treatment for COPD, including tailored exercise and education, but it is not available or suitable for everyone. There is potential for dance to be offered as a therapeutic intervention for people with COPD and other chronic respiratory diseases in several ways: by incorporation into existing programmes to increase the variety of exercise, post-PR as maintenance therapy, as an alternative for those who choose not to attend PR, and for those who are not offered PR.

In a busy general practice setting, some women’s health issues are perceived by the patients to have been dismissed with a prescription for Prozac, or just played down and the woman told that there is nothing wrong. Wanting women’s health issues to be addressed fully and respectfully is why the Royal College of Obstetrics and Gynaecology developed its publication and campaign, ‘Better for Women’, with the aim of steering the UK away from providing a disease intervention service towards a preventative health service, which addresses the determinants of health throughout the woman’s life course. Without doubt, some women’s health issues can be helped with medication; but this should not be the first approach. Further, medication is more likely to work well if women’s health and lifestyle issues are also addressed. Top diet and lifestyle issues include excess weight, lack of physical activity, and stress; and many of these are intertwined. Addressing these issues when dealing with the three top women’s health conditions: menopause, polycystic ovary syndrome (PCOS) and premenstrual syndrome (PMS), is essential — to move straight into the medication option and ignoring lifestyle changes often means the problem may never truly be solved long term.

In primary care, there is a lack of understanding and awareness among some clinicians regarding mental health issues that military veterans experience. The aim of the project outlined here was to identify military veterans in one primary care centre, screen them for anxiety and depression, and offer them the most appropriate treatment and support. An emotional health check template was used to identify military veterans for anxiety and depression. Training was also offered to staff in the practice and appropriate services were identified and listed on a leaflet. By the end of the project, the number of military veterans identified in the practice had increased from 19 to 200, 45 with a diagnosis of depression and five with post-traumatic stress disorder (PTSD). Only four veterans were offered emotional health checks during the project period due to restrictions in place for the COVID-19 pandemic. This article shows how the process of identifying military veterans and developing a system of screening for depression and anxiety as well as introducing new staff training has been effective. Adding missing elements to the template will improve follow-up and evaluation in the future.

Telephone and video consultations have become a prominent part of practice in the pandemic, bringing undoubted benefits but also some challenges. Due to the inability to examine patients or read their body language, successful remote consulting may call for some adjustments to the normal way of talking with patients. Here, Dr Roger Neighbour OBE, retired GP from Hertfordshire and a past President of the Royal College of General Practitioners, considers how to prepare for and begin a remote consultation, describing a simple seven-stage approach to clinical problem-solving: getting the story, doing the clinical work, and agreeing the management plan. It encourages you to think aloud as a way of keeping the patient involved, and offers some advice on bringing the conversation to a close.

Much-loved family recipes inspire intergenerational and international cookbook

People who are extroverted tend to seek social stimulation and opportunities to engage with others through social interaction. Yet, whether you have an introvert or extrovert personality, loneliness can strike anyone. Being an extrovert by nature, experiencing enforced lockdown earlier this year was initially extremely daunting and challenging for me. Although well past the ‘flush of youth ‘, I am still in a section of life where my calendar was filled with meetings, attendance at international conference/exhibitions, networking and travelling, giving me a purpose to manage my professional and home life with positivity.

Many men with prostate cancer do not experience symptoms until the disease has spread. This means that they risk being diagnosed too late, when the cancer is incurable. With your help, asymptomatic men with prostate cancer could be recognised earlier and their lives could be saved. Prostate Cancer UK believes general practice nurses (GPNs) are in a unique position, as they are ideally placed to recognise men at higher risk of prostate cancer and help ensure that prostate-specific antigen (PSA) testing is delivered to best effect.

Viscopaste and Ichthopaste bandages have been available in the wound care dressings market since the 1950s and 1930s respectively and are widely used within their clinical indications, primarily in lower limb management to treat leg ulcerations and the skin conditions associated with a leg ulcer. The products are commonly used within dermatology to manage chronic lichenified (thick and leathery) skin conditions, such as atopic eczema and dermatitis. Recently, Viscopaste and Ichthopaste bandages have been utilised in the management of skin conditions related to chronic oedema, for the treatment of patients with a diagnosis of red leg syndrome, which is often misdiagnosed as cellulitis (Elwell, 2014).