Call for interested medical writers

Writing for InnovAiT

Would you like to have a go at writing for InnovAiT? If you are a seasoned author with many publications under your belt or a first time writer wanting to give it a try, we would love to hear from you. Perhaps you are passionate about a specific topic that you would like to share with others? This is a great chance to help others learn about the important topics. We can also offer buddying support if you would like a bit of extra help and friendly tips to get you going. It is a great experience as well as offering the potential to have a publication to add to your CV.

We have a list of topics on our current areas of focus if any of these take your fancy, but delighted to also hear of other ideas for what you would like to see appear in InnovAiT:

Acute abdominal pain

Appendicitis

Acute breathlessness

Heart murmurs in children

Exercise and heart disease

Sexual health in people with learning or intellectual disabilities

Intellectual or learning disabilities

The role of the health visitor

Newborn hearing screening programme

Immune deficiency in children

Novel psychoactive substances

Controlled drugs

Emerging evidence on the role of hallucinogenics in medicine

Self-harm in adults

Self-harm in adolescence

Bladder cancer

Assessment of suspected cancer

Testicular pain

Peyronie’s disease

Testosterone deficiency in men and/or women

Knee pain

Hip and knee replacements

Safeguarding adults

The role of the WHO

If you would like to see your article in InnovAiT or just keen to ask any questions please do get in touch editorialoffice@innovaitjournal.co.uk or message us at Instagram rcgpinnovait2021, Facebook or twitter @RCGP_InnovAiT.

RCA video choices, UTIs, epilepsy and much more

With the Easter bank and May bank holidays as well as lighter mornings and evenings, there definitely feels a lighter mood in the air, which has felt very much needed. I hope that you have managed some time off – or have some coming up soon and to get outside.

As ever, we have a great selection of resources for you in the May edition of InnovAiT, so do head on over and take a look.

This month we have an excellent article by Patel and Patel who outline some principles around epilepsy and importantly what you need to do in the annual epilepsy review.

Do you know your lateral from medial epicondylitis? Are you clear on the presenting symptoms of olecranon bursitis compared with osteo or rheumatoid arthritis? Are you clear on the recommendations? When do you inject? When would you not? When do you refer? For a clear outline of all of the above, have a look at Dr Berezowka’s article on elbow pain.

Urinary obstruction can occur due to multiple different causes and understanding these is important to know how to best manage a presenting patient. Wilson et al’s article is a helpful resource to get you going.

With the Primary Care Network Direct Enhanced Service (PCN DES), tackling neighbourhood health inequalities and the clear direction in the Long Term Plan we are currently at a fantastic time of opportunity to really understand the population we are working with and reduce the health inequalities. The lecture review by Poppleton, Jones and Wright gives some background and ideas of application into general practice. I think we are taking great strides, but important to use this as the driver and basis of any change we undertake.

For those of you approaching the RCA, do take a look at Hana Patel’s Crammer’s corner for help in how best to select the best consultations… and really GOOD LUCK!

In the meantime, test yourself on this AKT question:

You see a 7-year-old girl with a urinary tract infection. The result from a recent microscopy, culture and sensitivities suggests growth of a pseudomonas species. This is her third confirmed urinary tract infection.

Which SINGLE first-line radiological investigations is MOST appropriate? Select ONE option only.

1. Computed tomography kidney, ureters and bladder
2. Dimercaptosuccinic acid scan
3. Micturating cystourethrogram
4. Ultrasound kidney, ureters and bladder
5. X-ray kidney, ureters and bladder

For the answer have a peek on here.

Quizzing into spring

I love a good quiz. Each month, InnovAiT is jam packed with fantastic AKT questions, so for our blog today I thought I would give you a bit of a quiz with the April edition questions. They all relate to the articles in this month’s InnovAiT – just click on the links beneath to find out more.

For those of you who celebrate – wishing you a very Happy Easter, and to all, despite the huge pressures on all of healthcare at the moment, hope you manage to get some time off to relax and enjoy the sunshine over the long weekend .

Question 1.

You review a young patient with long-term depression, anxiety and insomnia. He is currently on zopiclone 7.5 mg and has been for a long time. You are trying to ‘wean him off’ zopiclone and he is willing to try this.

Which SINGLE medication can be used to try and reduce the dose? Select ONE option only.

1. Clonazepam 2 mg
2. Diazepam 5 mg
3. Nitrazepam 10 mg
4. Oxazepam 3 mg
5. Temazepam 5 mg

Answer DOI: 10.1177/17557380221079703e. InnovAiT article: Dependence on prescription medication. DOI: 10.1177/17557380211070618.

Question 2.

You are trying to help a young lady with issues of drug misuse. She is struggling to stop her use of diazepam. According to the National Institute of Health and Care Excellence, brief interventions can be effective.

Which of the following SINGLE models can be used to help with brief interventions and motivational interviewing? Select ONE option only.

1. Berne’s transactional analysis model
2. Cambridge-Calgary model
3. FRAMES model
4. Pendleton’s model
5. SPIKES model

Answer DOI: 10.1177/17557380221079703g. InnovAiT article: Dependence on prescription medication. DOI: 10.1177/17557380211070618.

Question 3.

Gabapentinoids are now commonly used medications in primary care.

Which of the SINGLE following diagnoses is pregabalin licenced for? Select ONE option only.

1. Chronic low back pain
2. Fibromyalgia
3. Generalised anxiety disorder
4. Multiple sclerosis
5. Post-traumatic stress disorder

Answer DOI: 10.1177/17557380221079703i. InnovAiT article: Dependence on prescription medication. DOI: 10.1177/17557380211070618.

Question 4.

A 53-year-old patient presents with recurrent attacks of ear infection with foul discharge from the ear. On examination, a small collection in the retraction pocket of the attic of the ear canal, near the ear drum can be seen.

What is the SINGLE MOST appropriate management option? Select ONE option only.

1. Refer for incision and drainage
2. Refer for microsuction
3. Refer for surgical excision
4. Start oral antibiotics
5. Start topical antibiotic ear drops

Answer DOI: 10.1177/17557380221079703m. InnovAiT article: Hearing loss: Conductive versus sensorineural. DOI: 10.1177/17557380211070030.

Question 5.

You have decided to give a steroid joint injection for a patient’s knee osteoarthritis. The patient requests a local anaesthetic prior to the procedure.

Which of the following is a low potency local anaesthetic with a fast speed of onset and moderate duration of action? Select ONE option only.

1. Amethocaine
2. Bupivacaine
3. Lidocaine
4. Prilocaine

Answer DOI: 10.1177/17557380221079703c. InnovAiT article: Local anaesthetics: Theoretical aspects. DOI: 10.1177/17557380211035167.

Question 6.

A 65-year-old patient presents with hearing loss affecting both ears. On examination, you note impacted cerumen, which is viscous with an oedematous canal.

What is the SINGLE MOST appropriate NEXT management option? Select ONE option only.

1. Ear syringing
2. Refer for microsuction
3. Self-limiting and no action required
4. Suggest a trial of removal using cotton buds
5. Trial of olive oil ear drops

Answer DOI: 10.1177/17557380221079703k. InnovAiT article: Hearing loss: Conductive versus sensorineural. DOI: 10.1177/17557380211070030.

Question 7.

Local anaesthetic preparations have multiple uses in general practice.

Which of the following SINGLE medical conditions would a lidocaine-containing preparation be MOST appropriate to treat? Select ONE option only.

1. Anal fissure
2. Aphthous ulcer
3. Carpal tunnel syndrome
4. Lichen planus
5. Trigeminal neuralgia

Answer DOI: 10.1177/17557380221079703a. InnovAiT article: Local anaesthetics: Theoretical aspects. DOI: 10.1177/17557380211035167.

Question 8.

You are seeing a 24-year-old patient with chronic pelvic pain. You suspect endometriosis.

Which SINGLE investigation is diagnostic in endometriosis? Select ONE option ONLY.

1. Day-21 progesterone
2. Laparoscopy
3. Magnetic resonance image (MRI) scan
4. Serum prolactin
5. Transvaginal ultrasound scan

Answer DOI: 10.1177/17557380221079703o. InnovAiT article: Chronic pelvic pain in women. DOI: 10.1177/17557380211073165.

Question 9.

You are seeing an 18-month-old girl with vomiting and watery diarrhoea. Mum is asking about a possible cause for her symptoms.

Which SINGLE virus is MOST likely to cause gastroenteritis in children? Select ONE option only.

1. Adenovirus
2. Astrovirus
3. Campylobacter
4. Norovirus
5. Rotavirus

Answer DOI: 10.1177/17557380221079703q. InnovAiT article: Food-poisoning. DOI: 10.1177/17557380221079703r.

Question 10.

You see a 34-year-old patient with gastroenteritis that has lasted for about 10 days. His stool microscopy, culture and sensitivity (MC&S) shows Gram-negative rods.

Which SINGLE pathogen is MOST likely the cause of his gastroenteritis? Select ONE option ONLY.

1. Bacillus cereus
2. Escherichia coli
3. Giardia lamblia
4. Listeria monocytogenes
5. Staphylococcus aureus

Answer DOI: 10.1177/17557380221079703s. InnovAiT article: Food poisoning. DOI: 10.1177/17557380211073346.

Big shoes and haematology

I was delighted to have been asked to write the editorial for this month’s special haematology edition of InnovAiT and was extremely conscious of the big shoes I temporarily filled.

I have a portfolio of roles, as many of us do, and another I enjoy is in clinical leadership. I work within a Clinical Commissioning Group (CCG), soon to transition to an Integrated Care Board (ICB) as part of the overarching Integrated Care System (ICS). Speaking to my GP peers, much of this change feels a bit distant and remote from daily GP work, but the transition will change how providers (including the acute hospitals, community trusts, mental health trusts and of course primary care) work and collaborate to plan and coordinate patient care. The CCGs are comprised of GP practices in membership, but with primary Care Network (PCN) development and the developing Neighbourhoods and Place based partnerships, primary care leadership will change dramatically. I find my role hugely rewarding, but occasionally challenging, especially with the relentless and urgent needs of the pandemic; something we are all familiar with. I recommend you maintain a good understanding of organisational changes as they will shape the way we work.

One of the positives for us as a family in pandemic lockdown, was the offering of National Theatre At Home. It was a chance to be transported to another world and we were able to watch plays that we would ordinarily not have taken trips to see. The children were captivated particularly by the Madness of King George III. The horror at treatments he endured provoked lots of questions. We discussed his affliction and the current understanding that mental illness was the cause, although, for a long time it was thought to be porphyria, a haematological condition. This prompted yet more questions from the children and reminded me why I admire haematology as a specialty, a specialty encompassing in-depth knowledge, laboratory skills, management of long-term conditions and conditions sadly more life limiting.

This issue may not shed light on King George III, but our light will shine on haematology, a specialty we need to understand well and I hope better from the articles in this issue. We start this month with an article on interpreting the full blood count by Martin Haywood, and one to bookmark for the end of surgery when you go through your list of results. Dominique Forrest’s article on platelet disorders is similarly a fantastic resource to read, but also to have to hand.

Thalassaemias are among the most common genetic disorders worldwide, but depending on your practice population, their heterogeneity means they are not often managed or considered in primary care. The article by Johanna Wong, gives a clear overview of the different forms and key management options. In some areas of the country, you may have a locally commissioned service to pay the practice for taking on additional workload, such as the monitoring of monoclonal gammopathy of undetermined significance (MGUS). There are many benefits for the patient, but it requires a good level of knowledge by the primary care clinician. Fortunately, Vui Yung Chieng and Rod Sampson help the acquisition of this knowledge with their synopsis of this pre-malignant plasma cell disorder.

Lymphoma for GPs by Samuel Merriel contains clear guidance and a comprehensive management plan for common presenting symptoms. Emma Hyde-Nero et al., in diagnosing leukaemia, describe when we should speak to a haematologist or admit patients, and not make a 2-week rule referral. They also outline key symptoms and discuss emergency leukostasis, which has a 1-week mortality of 40%; so important not to miss.

Other haematological emergencies can be as dramatic and are outlined by Amy Tannatt Nash and Harry Hambleton. They give a clear patient perspective on what to expect and how patients should be managed, which is so helpful when giving support to patients.

So yet again, pandemic or not, this month’s edition contains great clinical information to keep you up to date, as well as regular offerings such as our AKT questions and the topical nuggets within News and Views. I hope you enjoy reading the articles as much as I have.

Now we are online only, don’t forget to sign up for eTOC email alerts so you know when the latest edition has been published https://journals.sagepub.com/connected/INO#email-alert

You can also sign up for the blog at RCGPInnovAiT | RCGP InnovAiT Journal Blog (wordpress.com) and of course follow us at:

Did you catch February’s edition?

With the current events in Ukraine, it is incredibly hard reading through the horror that others are going through. For some of you, this may be loved ones and people you know and care about. I hope that you feel able to share with colleagues how this is impacting you and those around you are offering their support. Please reach out. NHS Health practitioner is also there if you need help.

With everything happening alongside the usual work pressures, you may have missed February’s edition of InnovAiT – so here is a brief recap of what fantastic information it contained so you can catch up.

To start, imagine you are in your first ST3 general practice placement. You are fairly comfortable as you enjoyed your ST1 GP placement and pleased to be back in primary care. You notice third on your clinic list you have ‘annual asthma check’. Slight panic sets in – doesn’t the nurse usually do these? You are familiar with seeing an acute asthma patient (because you have already read the great Acute asthma article by Dr Wong), but what are you meant to do for an annual review? Well panic not. The article by Dr Shangavi will talk you through all you need to cover and how to approach issues with the patient. There will also be a template for you to complete and boxes to tick to make sure it is all coded too – so if you can’t find that on your system, do make sure you ask one of your team.

While you are going through your clinic, you are trying to collect your recordings for Recorded Consultation Assessment (RCA), but STOP! Make sure you first read Dr Patel’s second of two articles containing really helpful pointers which are not to be missed.

Now, your next slot is an 11 year old girl, but the appointment notes say she is at school and you need to speak to her mum. Mum has received a letter saying her daughter was weighed by her school nurse who says she is overweight and needs to see her GP. Again, no need to panic, Drs Patterson, Sornalingam, Hannah and Cooper are here to help you through. Their fantastic overview of how to approach childhood obesity contains the key medical and safeguarding considerations as well as some really helpful tips and ways to phrase your conversations.

If your educational supervisor review is also coming up, and in amongst the busy clinic, you are also thinking how you can cover the equality and diversity sections of the curriculum, Prof Howe’s article will give you some great inspiration. More importantly is the recognition of our need to challenge ourselves and colleagues as to the prejudices we hold. As a society there have been great strides in identifying this need but still so much to do to address it – so I would thoroughly recommend making sure you read this article so that we can, as the title suggests, make healthcare better for all.

Finally, your last appointment is about the pill. Hooray, this is again familiar territory, you know the missed pill rules, what contraindications you need to consider and the risk benefit conversation to have. However, when the patient explains that she is already on the pill but would like to know about a quadraphasic pill as she has noticed some specific symptoms you realise you might need to have a re-check. It’s ok though because you quickly pull up this article by Dr Patterson and you are back on track.

What a day!

An apple for the teacher – creating the best learning environment in clinical settings.

I am delighted to share this fantastic blog with you from Dr Pauline Morris. Many thanks Pauline.

When I reflected on my time as both a student and a teacher in my clinical ventures on wards, in clinics and in my domain- theatres, I came to the conclusion (not a new one admittedly), that it’s not easy being a good teacher OR a good student!

Despite these being fundamental skills in medicine, the learner-trainer interaction, is not well taught and we are often left to figure it out on our own.

This little blog is not about the theory of education, but rather the neat little strategies that will allow you to have meaningful teaching and learning interactions as student and teacher, within the often chaotic environment of clinical work.

All the strategies are learner-focused, but also meant to reinforce the mentor-mentee relationship that underpins the apprenticeship of medicine.

My time spent obtaining a postgraduate certificate in medical education and contributing to the field of medical education as a mentor and appraiser, clinical and educational supervisor along with facilitated course instruction and simulation has presented me with many opportunities to test out these strategies that I’ve collated for you.

These little titbits don’t require any special equipment (but some preparation) and are designed so that you can implement them into your teaching and learning strategy today!

The learner:

Prepare for Learning– Clinical environments rarely present the opportunity for didactic teaching, so be prepared, do your reading/research, have an idea of what you want to get out of the day and share it with your teacher/trainer.

The Learner/Teacher Interaction– Be considerate- your teacher may not have been expecting you, or they may have just finished a difficult case or conversation. Expect to contribute to the care of the patient. Ask what you could do to help. Getting tasks out of the way means more time and focus on you!

Feedback- You should expect to get feedback after training interactions. If you haven’t had any, please ask your trainer to provide some. Feedback can’t always be positive and may even be difficult to hear or accept. Be sure to ask questions and try to clarify where the need for improvement may be.

Remember feedback is generally difficult for the receiver and the giver (they will not always get it right!)

Assessments– Ask your teacher/trainer right from the start for the assessment post event. This allows them to assess you fairly. Remember, the clinical situation may not be conducive to you being assessed and you will not always be able to be signed off as competent, make sure you ask for feedback if and when that does happen.

The Teacher:

Prepare for Learning– Have an idea of the curriculum for your potential trainee/student. If this is not possible, ask them. Ask the trainee/student what they would like to get out of the day.

Have a plan- which is appropriate to the level of the learner. Whenever possible link teaching/training to present clinical situation.

The Learner/Teacher Interaction– When you’re not prepared for a training session, you may just need a few minutes to get yourself together. A nice gesture could be to sponsor the trainee for a nice coffee whilst get yourself in the right mindset!

Feedback- Give feedback with care, at the right time and right place. In private if needed, be specific about what went well and where there is room for improvement. Pay attention to the recipient’s reaction you may have to change your tactics and delivery!

You too should illicit feedback from the learner on your teaching/training content and skills. I even ask my team and the patients for their observation of the teaching session!!

Assessments– Expect to have to complete assessments. It often doesn’t have to be there and then, but asap to maintain as much accuracy as the human mind can!

Summary

I do hope I’ve made it obvious that the learn/teach paradigm are two sides of the same coin (if I haven’t, I apologise I meant to!), in an apprenticeship such as medicine, perhaps they can be no other way. We do all spend a considerable amount of time in both roles concurrently and simultaneously!

In Conclusion

• Remember you’re both human and make mistakes; we all have bad days.

• Be kind and appreciative.

• Learning/teaching should have some elements of fun!

• Remember the patient in all this- Consent, Permission and Respect.

Dr. Pauline Morris. Consultant Anaesthetist, Career and Personal Development Coach, Author, Founder of Doctors Caring for Doctors. dcd@coachingwithdrpauline.co.uk

Happy New Year, let’s hope it’s a better one

I am writing this with a glorious crisp blue sky outside which is definitely helping with the optimism for 2022. It would be hard though, not to also recognise the impact of Omicron on the population. Hoping that London has reached the peak of the wave, alongside other areas still rising and bracing ourselves for those becoming more unwell over the next couple of weeks. On a personal level though, I really hope you have managed to get some time for rest and recuperation over the festive period – and hopefully even managed to squeeze in some fun!

New year is always a great opportunity to set out our goals for the year ahead. A standard resolution of mine is to be more active – whether this is exercise, activities or just out and about more – always a challenge, especially with the dark mornings and evenings at the moment, but it helps so much with giving the time for headspace.

If one of your new year goals to try something new, perhaps even to get involved with InnovAiT, there is a perfect opportunity as the advert has just come out for Assistant Editor. Applications from all AiTs and GPs with an interest in GP training are very welcomed. 

Reporting to the GP Editor, the Assistant Editor will commission articles, arrange peer review, review and edit articles, and checking article page proofs. The Assistant Editor will write a variety of short articles or contribute to regular features with the support and supervision of the other editors. The post offers the opportunity to learn about all aspects of authoring and publication. Previous writing, reviewing or editing experience, and familiarity with the educational requirements of trainee GPs is desirable. This paid post will be done online, remotely, and will take up 1–2 hours per week. For more details:  https://jobs.rcgp.org.uk/job-details/12347/assistant-editor-innovait-journal-nationwide/.

Assistant Editor, InnovAiT Journal – Nationwide | RCGP Jobs Part time, 0.5 sessions per week (1-2 hours) Fixed term contract Location Nationwide Close date: 14 February 2022 Interview date: TBC The Royal… jobs.rcgp.org.uk

The first edition of InnovAiT for 2022 is setting the bar high for some great articles. A fascinating one on Medical Professionalism which, as someone who uses social media a lot, was a really helpful reminder of our role as well as the wider changes in how need to protect ourselves and our patients. Harmful drinking and alcohol dependence can often be exacerbated over the festive period, and this article has some very practical tips on how to support patients in primary care. Another article with some very practical approaches is by Cooke-Jones and Humphries around Urethritis in men.

For those of you approaching your RCA it is worth having a read of this month’s Crammer’s corner which has some fantastic hints and tips. On a similar note, telemedicine is something we are familiar with in primary care now, but not something that we have necessarily been trained to use. So do have a read of this helpful guide – especially if you are coming to your first primary care post.

What’s this? If you haven’t seen this section in the journal before, I would recommend it – great for a quick challenge. See what you think of the below.

What’s this?

A 6-year-old presented with scalp abscess. This was her third attendance with the same issue. The lesion had initially appeared as a circular patch of hair loss for several weeks and was treated with a 2-week course of ketoconazole 2% cream. However, it progressed into an inflammatory mass and antibiotics were given. The lesion persisted despite completing the full course. On inspection, she had a large, erythematous, boggy mass with purulent discharge and alopecia. In addition, she had ipsilateral cervical lymphadenopathy.

Answer and more information here.

Happy holidays – we hope.

Spot the medic giveaway

As if 2021 hadn’t been busy enough already, we are now ending the year with Omicron and the absolutely Herculean response of primary care teams to yet further increase the vaccination campaign. You are all AMAZING. Thank you so much for keeping patients safe and no doubt sacrificing personal or family time to keep things running. It is hard therefore, to talk of Christmas or time off. Many trainees in hospital placements will be working shifts throughout the festive season and those in GP placements are likely to be doing additional sessions in vaccination clinics, supporting out of hours or in the incredibly busy surgeries. I do hope you still get some leave and able to look after yourselves too – whether celebrating Christmas or not, it is crucial to have the chance to check in with how things are going and please do reach out if not. 

With this feasting season upon us, it seems only right that the first article in December’s InnovAiT is about the mouth – Oral mucosal manifestations of systemic disease to be precise. The many images are such a helpful guide in the offering from Iles et al. Dr Iles then goes on to discuss specialised dental services which can be so helpful to be aware of especially for more complex patients or those with learning disabilities for example. You will know that GPs are not responsible for managing dental emergencies and BMA guidance is clear that we should not attempt to treat without necessary training or expertise. Our role here is identifying appropriate teams for signposting to and recognising which patients may be at high risk.

Continuing with the face theme, the article on Bell’s palsy by Cull and Coleman is an excellent run though of this condition which we are likely to see a case of each couple of years – and is one which is great to be confident in diagnosing. Much less common though is a Child with facial nerve palsy, as described by Borg et al.

I really want to draw your attention to the fantastic article by Charles Holden and Duncan Shrewsbury The transgender patient in primary care. It is an essential read for all of us. As you may know, the waiting times for Gender identity clinics can be counted in years across the country, and the support we offer as GPs is crucial. The information in this article starts with the basics such as use of pronouns – which are so important to feel comfortable with. The issues around bridging therapy, non-prescribed hormones, shared care agreements and gender recognition certificates are also discussed and are absolutely hot topics.

Another interesting area is that around Artificial intelligence and it’s impact on general practice. Other than thinking of Steven Spielberg’s already 20 year old film, it is not something I have considered much – and certainly not relating to being a GP, but this article is a fascinating look at its applications.

Having received a request for an Instagram account, we have set one up – with over 100 followers in the first week which is fantastic. If you aren’t one of those 100 people, please do join us rcgpinnovait2021. We are still on Twitter @rcgp_InnovAiT and Facebook @RCGPInnovAiT too.

So before your last blog AKT question of 2021, I would like to wish you a very Merry Christmas and Happy New Year. Keep being amazing.

Single Best Answer

You see a 29-year-old lady with pain around her tongue. She has been to the dentist who has advised there are no dental causes to the pain.

On examination, she has erythema to the dorsum of her tongue, as well as the following areas around her lips.

^©Cardiff and Vale University Health Board and Guy’s and St Thomas’s NHS Foundation Trust.

What is the SINGLE MOST likely cause/diagnosis? Select ONE option only.

1. Candida infection
2. Fungal infection
3. Iron deficiency
4. Vitamin B12 deficiency
5. Vitamin D deficiency

To find the answer click here

Remember, Remember the InnovAiT from November

This month’s edition of InnovAiT contains an article which I was so excited to read. Firstly, it is written by a truly inspiring female medical leader, Professor Amanda Howe, who is also based in my childhood city of Norwich, at the fantastic University of East Anglia. In my much younger years I loved visiting the Sainsbury Centre art gallery at the UEA, surrounded by the wonderful Henry Moore sculptures, and spending evenings in the lower common room watching Manic Street Preachers, Jamiroquai and Pulp amongst others. So any association with those fond memories always piques my interest. The other probably more important reason I was keen to read this article is because it is about Leadership in Primary Care. I never thought of myself becoming involved in leadership as such, but on reading Prof Howe’s article I can now see how the clues were there for many years before taking on a role which could be considered as leadership, which I really enjoy. I wish I had read or heard something as clear and helpful as this many years ago and even if you think this doesn’t apply to you I really encourage you to take a read.

The article by Quereshi and Nawaz was also of interest to me having recently seen young slim patient with a short history of typical raised glucose symptoms and glucosuria. It is a helpful reminder of key diagnostic features of maturity onset diabetes of the young as well how to assess such patients.

A question I am often asked – at and outside of work, particularly now venturing into having teenage children, is how to manage acne. The article by Pathak and Dattani on Acne Vulgaris reminds us of how to assess and treat the condition. What I really love about this article is they go on to also discuss different individual situations – pregnancy and breast feeding, transgender patients – particularly those receiving testosterone, as well as how to approach different skin types appropriately. The impact – positive and negative – of social media on management of acne is also openly discussed. These aspects really bring Acne management up to date.

Another area which I found the update so helpful for having a clear approach is Management of erectile dysfunction in primary care by Varma and Sellaturay. The flow charts are perfect for easy reference how to guides as well as the table of specifics around which PDE5i to use. Flow charts now added to my bookmarks – thank you!

AKT question

You see a 36-year-old man with nasal congestion and rhinorrhoea. The symptoms are associated with intermittent facial pains in his cheek bones and both sides of his forehead. This is worse on bending forwards. He does not have a history of a fever. He is eating and drinking well.

On examination, his observations are normal but there is evidence of thick clear nasal discharge. He does have bilateral facial tenderness.

Which of the SINGLE following options most accurately depicts how long his symptoms are likely to last? Select ONE option only.

1. 4 days
2. 1 week
3. 1.5 weeks
4. 2.5 weeks
5. 3 weeks

Click here for the answer

Happy Halloween

Despite it being Halloween today, I’m afraid the October edition of InnovAiT is rather without articles on pumpkin toxicity, chainsaw escapades or goulish stories. However, it is jam packed full of fantastic reads nevertheless.

The first one I wanted to mention is a short but powerful article on foreign body ingestion in children. An urgent presentation with what could be easy to miss, subtle symptoms.

Menopause has been all over the media recently and certainly I am seeing many patients who are much more aware of their options. Yesterday’s announcement of the government’s proposal for the change in prescription options for HRT again enforces that as GPs, management of menopause is not just for women’s health specialists in primary care but something we all need to feel confident with. The article by Hand, Gray and Simpson is a superb high level overview of the key points that we need to know and gives a brilliant, clear discussion of a topic which can often feel confusing with the number of studies available. This is an absolute must read article and one to have easy link to for when you’re in clinic.

Ovarian insufficiency is one of many causes of amenorrhoea and the article by Drs Munjal and Nair offers a very logical walk through how to approach the different presentations of this with some very helpful case studies as well as talking through the risks of amenorrhoea.

When a women mentions that she suffers with dyspareunia, it is something which I always want to support her with really well, but know I may struggle in the 10 minute consultation. Having read the article on this important topic by Morris, Briggs and Navani, I am hopeful that having a clear approach will help but also ensure I can ‘do well’.

Another area which can feel a minefield until you have worked your way through scenarios with patients is that of mental capacity act. It is crucially important to get this right and the article this month by Dr Neilson is a good place to start, especially if you’re not sure about the answer to the question below.

You see a 73-year-old patient who has recently been diagnosed with mild cognitive impairment. She is looking to appoint a family member to make decisions on her behalf should she lack capacity to make decisions in the future.

Which SINGLE legal term is MOST appropriate? Select ONE option only.

1. Enduring power of attorney
2. Independent mental capacity advocate
3. Independent mental health advocate
4. Lasting power of attorney
5. Support worker

So if you are celebrating Halloween today, enjoy! Hope there are lots of treats and not too many tricks out there.