Risk factors Resources

Pernicious anaemia is a rare condition which is classed as an autoimmune disease. It is most frequently diagnosed in those over the age of 60, but can occur at any age. It presents with variable symptoms, many of which are shared with those of other diseases, making the condition difficult to diagnose, leading to missed diagnosis and a greater risk of
complications. This article gives an overview of its diagnosis, management, and  complications, with the aim of helping general practice nurses (GPNs) and non-medical prescribers recognise symptoms and get early treatment, reducing the risk of long-term adverse effects and improving quality of life for all those affected by this complex disease.

When patients present with red lower legs, the cause is often assumed to be cellulitis or erysipelas. There are, however, several alternative conditions which mimic the clinical signs of cellulitis or erysipelas, which can lead to misdiagnosis. It is important that the cause is correctly diagnosed to prevent inappropriate prescribing of antibiotics. This article discusses the different potential causes of ‘red legs’, in addition to cellulitis and erysipelas, together with clinical signs and symptoms to enable general practice nurses (GPNs) to differentiate between them and implement appropriate treatments

There are many different causes of liver disease and current estimates suggest that as many as one in 10 people have problems with their liver at some time in their life (Foundation for Liver Research, 2020). Perhaps most worrying is the fact that incidence of liver disease is increasing, with the number of deaths reported to have increased by 400% since 1970 (British Liver Trust, 2020). Most liver diseases are asymptomatic early on, frequently resulting in late diagnosis, potentially leading to a higher risk of poor outcomes. Many of the well-known liver diseases are preventable and this article, which covers fatty liver disease, hepatitis A, B and C and liver cancer, hopes to raise awareness of risk factors, recognition, causes and treatment of these conditions, and give general practice nurses (GPNs) and non-medical prescribers more confidence when caring for patients with these illnesses.

Surgical wound dehiscence develops when the edges of a surgical incision separate along the suture line due to infection or suboptimal healing, leading to an open wound. Surgical wound dehiscence can have a significant impact on the patient’s quality of life, increases the demands on healthcare professionals’ time and is costly to the health economy. Over 50% of patients with surgical wound dehiscence are managed in the community and treating these types of wounds is challenging. General practice nurses (GPNs) need to be aware of those patients that are more likely to present with surgical wound dehiscence and take a preventative approach, as well as understanding the principles of best practice for assessment and management when caring for this group of patients.

Over the past five years, NHS commissioners have started to practise outcomes-based commissioning. Many of the new provider-led models of care heralded in the Five Year Forward View (NHS England, 2014) build on the concept of ‘accountable care organisations’ (ACOs). The ACO model is predicated on payment for outcomes.

While still in its infancy, our understanding of outcomes that matter most to people and families is growing — and those outcomes may be different to the clinical biomarkers we have traditionally measured.

Accounting for person-centred outcomes would fundamentally change conversations with patients and the focus of clinical practice, because we would worry less about the numbers and more about supporting people to live full, productive lives. Let’s imagine how that might work.