19 March 2018

01 September 2021

The National Review of Asthma Deaths (NRAD) (Royal College of Physicians [RCP], 2014) identified many shortcomings in the way that asthma care is delivered, citing preventable factors in 90% of asthma deaths. Among deaths in children, poor recognition of risk of adverse outcome was found to be an important avoidable factor in 70% of deaths in primary care, rising to 83% in young people (RCP, 2014). The challenges of the pandemic over the past 18 months have arguably compounded the difficulties in providing good asthma care, with asthma reviews necessarily being managed in different ways, largely undertaken remotely. To further prevent avoidable deaths, it is important that primary care nurses are confident and competent in undertaking remote asthma reviews so that risks of adverse outcome are identified and effectively managed. As highlighted by the NRAD, parents/carers and children should be taught ‘how’, ‘why’ and ‘when’ to use their asthma medication, be able to recognise when asthma is not controlled, and know when to seek emergency help. This article gives a structured approach to undertaking a remote asthma review with children so that good asthma control and better outcomes can be achieved.

07 June 2022

The six to eight-week infant examination is undertaken in primary care, predominantly by GPs, and is a vital repeat examination of the newborn infant physical examination (NIPE) to ensure that any congenital abnormalities are not missed, as some may not become apparent until this age. Although national standards exist for the NIPE in the form of the NIPE handbook (Public Health England [PHE], 2021), no such national standards exist for the six to eight-week infant check.

02 October 2017

Long-term conditions: compression therapy and venous leg ulceration.

Compression therapy is the recommended treatment for the prevention and management of venous leg ulceration and lymphatic insufficiency (Scottish Intercollegiate Guidelines Network [SIGN], 2010; Harding et al, 2015; Wounds UK, 2016). Various methods of delivering compression are used in the UK, including bandaging, hosiery and Velcro® wraps. Selecting the correct device can be challenging for clinicians. This article explores the different compression systems available to help general practice nurses (GPNs) make appropriate choices for their patients, i.e. an option which is acceptable to the patient and can be applied safely and proficiently.

05 September 2022

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.

07 June 2022

This article, the first in a two-part series, aims to raise awareness of upper airway disorders, as defined by the recently published upper airway disorders position paper from the Royal College of Speech and Language Therapists (RCSLT; Haines et al, 2021). It provides a summary of the aetiology and clinical presentations for persistent throat symptoms, refractory chronic cough, and inducible laryngeal obstruction. These disorders are primarily related to laryngeal dysfunction, rather than lower airways disease, virus, or infection. Recognising the immense time pressures within clinical practice, tables have been included that could be provided to support patients with understanding their symptoms. Part two will look at managment approaches, including self-care strategies, and advice on where to refer people presenting with upper airway disorder symptoms.

07 June 2022

As the NHS pivots towards innovation to address the Covid-19 backlog, support overburdened staff and elevate standards, it might be all too easy to assume that much of the focus will be on digital technologies and cutting-edge concepts. 
However, to establish a better health service, it is imperative that careful consideration is given to all areas of medical supply — not just the big-ticket items of equipment and digitalisation of services, but also the simpler items which can make a huge impact on patient outcomes, such as compression hosiery.

09 July 2015

Long-term conditions: chronic obstructive pulmonary disease.

The use of spirometry as an objective measurement in the diagnosis of chronic obstructive pulmonary disease (COPD) is widely acknowledged and discussed in guidelines about COPD, as well as those specific to spirometry (British Thoracic Society [BTS]/Association for Respiratory Technology and Physiology [ARTP], 1994; Levy et al, 2009; National Institute for Health and Care Excellence [NICE], 2010; Primary Care Commissioning [PCC], 2013). As a relatively simple test to undertake, it has been performed in primary care for several years now but with varying degrees of expertise and understanding (Strong et al, 2014). The standard of secondary care lung function testing (LFT) has never been questioned. Overall, this inequity of testing has resulted in an estimated 50% of people having an incorrect diagnosis (Tinkelman et al, 2006). This results in people taking medication they do not need, or not receiving treatment they do. This article will enable the reader to identify gaps in their own knowledge about the use of spirometry in COPD diagnosis.

25 February 2016

Spirometry is very easy to do, and very easy to get wrong (Martin, 2010; personal communication). Not only is quality
assured spirometry dependent on the effort exerted by the patient, and the technical ability of the spirometer operator,
but also on the understanding of the results by the person interpreting them.

Interpretation of the results is essential if any meaningful decision is to be made about the patient’s care.

05 December 2022

Professional networking is a valuable tool to build advantageous professional support systems of people who will advise, encourage and enhance healthcare practice (Donelan, 2014). Networking benefits include increased engagement and insight
into healthcare policy and subsequent changes and trends in the professions, along with better opportunities for career advancement (Meiring, 2018).