Resources

Worldwide gout is the commonest type of inflammatory arthritis. It is often misdiagnosed and poorly managed (Dehlin et al, 2020). Gout can be diagnosed and treated in primary care and is amenable to nurse management (Doherty et al, 2018). This article will help readers to be able to diagnose and manage gout, as well as how to be aware of and treat
acute gout and prevent further episodes. Certain conditions increase the risk of gout and this article advocates a holistic approach to improve overall health.

The United Kingdom (UK) has a comprehensive national immunisation programme which comprises both routine and selective immunisation schedules (UK Health Security Agency [UKHSA], 2023). The routine programme includes those vaccines offered to the population, with eligibility predicated on age. For the last few years, vaccine coverage has been
falling in the majority of children’s and young people’s immunisation programmes (UKHSA, 2022; UKHSA 2023a; UKHSA 2023b; UKHSA 2023c). The decline in coverage has been made worse by the Covid-19 pandemic and consequent lockdowns, illness among recipients, and confusion and hesitancy about vaccines in general. This article discusses the drop in coverage of the adolescent immunisation programmes in England, and the role that general practice nurses (GPNs) and primary care immunisers can play in ensuring that young people are offered missing vaccines. The benefit of this catch-up activity is seen in reduced risk of morbidity and mortality from vaccine preventable illness in both individuals
and those around them.

Peak expiratory flow rate (PEFR) is the volume of air forcefully exhaled at maximum speed. This can be measured using a peak flow meter or a spirometry device. Peak flow meters are portable, inexpensive and widely available. The technique is non-invasive, carries no risk to the person, can be taught and learned quickly, and can easily be mastered by the patient. Published evidence for the use of peak expiratory flow rate (PEFR) and peak flow monitoring in asthma is limited, despite the use of the peak flow meter being documented in national and international guidelines for many years. National and international guidelines recommend the use of easily calibrated spirometers, which can provide accurate results
with good technique, along with fractional exhaled nitrous oxide (FeNO) testing, which requires a greater analysis and interpretation of the results. Is the use therefore of the peak flow meter redundant? This article discusses the indications for use of peak flow meters, technique and clinical context.

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.

A primary concern for many cancer survivors is getting cancer again or it returning. Unfortunately, recurrence can happen but there is evidence that dietary interventions, generally combined with physical activity, improve overall quality of life and give the body the best chance of warding off recurrence. Being the right weight for height is also important.This article explores dietary and lifestyle considerations, dispels some myths, and considers other aspects of diet and lifestyle and prevention of cancer recurrence, such as alcohol intake, physical activity and food-borne disease. It also looks at the role certain sweeteners may have, along with ultra-processed foods, use of certain supplements and the role of fibre. Definitive evidence is often not available for this aspect of cancer, but this article presents the most up-to-date findings. Specialist post treatment palliative care is not covered.

The population is ageing and so we are seeing an increase in the prevalence and incidence of age-related conditions, such as frailty and dementia. These two conditions can often go ‘hand in hand’, making it important to ensure appropriate recognition, assessment and then management of each when experienced together. This paper uses a case study approach to illustrate and discuss the issues.

Nurses and nursing leaders continue to be overwhelmed by increasing challenges as the call to demonstrate higher levels of resilience gains momentum. And yet nurses continue to be faced with unparalleled levels of adversity, leading to a loss of hope, with many choosing to leave the profession rather than continue to be exposed to unyielding levels of stress that have the potential to threaten the survival of the profession itself. With this in mind, this paper focuses on the importance of nurses working collaboratively through the process of coaching, a construct gaining momentum as the profession seeks to expand and facilitate new ways of working in order to develop both current and future nursing leaders and, in so doing, not only strengthen the voice of nursing, but also improve the way in which nurses practice.

Asthma is an inflammatory condition which leads to narrowed and hyperresponsive airways. In recent times, the standard approach to managing asthma has been to use an inhaled corticosteroid (ICS, the preventer) to dampen down the inflammation and a short-acting bronchodilator (the reliever) to open up the airways if the person with asthma needed symptom relief. If the preventer inhaler is doing its job, the reliever should not be needed more than three times per week. The British Thoracic Society/Scottish Intercollegiate Guidelines Network guidelines currently reflect this approach (BTS/ SIGN, 2019), but later this year these guidelines will be updated based on a collaboration with the National Institute for Health and Care Excellence (NICE). NICE previously published its own asthma guidelines, which were controversial in terms of their recommendations, with a focus on using preventer therapy if a reliever was needed three times a week or more, rather than prioritising the use of anti-inflammatory treatment for an inflammatory condition. It will be interesting to see what the joint recommendations will be. In the meantime, many clinicians with an interest in asthma management are looking to the Global Initiative for Asthma recommendations for a fresh approach to asthma management (GINA, 2023).

I found the ‘Practice matters’ article about GPNs and the additional roles reimbursement scheme interesting on several levels. First, it reminds me how well placed we are as GPNs to deliver holistic personalised care across the whole population. Patients regularly
feedback that they like seeing a clinician who can listen to and help with a wide range of health issues.

The Queen’s Nursing Institute (QNI) has significant concerns about the additional roles
reimbursement scheme (ARRS), particularly the impact on general practice nurses (GPNs). With NHS England’s ARRS now funding 17 multidisciplinary team roles in primary care, the QNI is disappointed to see the continued exclusion of GPNs from the scheme.
Many practices are now employing large numbers of staff through the ARRS, with GPNs being required to support new starters, despite being excluded from recruitment into
the scheme.