Home oxygen is widely used in the clinical management of patients with conditions that result in chronic breathlessness. It is often requested by patients and their families, particularly when they have been treated with oxygen during a hospital admission with an acute worsening of hypoxaemia. However, oxygen therapy at home is not an insignificant undertaking; it may be challenging for both patients and their families and carries a number of risks in terms of safety and clinical response to treatment. The British Thoracic Society (BTS) has published detailed evidence-based guidance for the assessment, prescription and follow-up of oxygen therapy in the home setting (Hardinge et al, 2015). This article addresses the main points of the guidance and considers the role of primary care health professionals, such as general practice nurses (GPNs), in supporting patients with chronic breathlessness and identifying those who might benefit from assessment for home oxygen therapy.
Prostate cancer is the most common cancer diagnosed in men in the United Kingdom (Cancer Research UK [CRUK], 2016). In 2013, there were 47,300 men diagnosed with prostate cancer. This amounts to 13% of all new cancers diagnosed in men. Furthermore, prostate cancer incidence has increased by 5% over the last ten years (CRUK, 2016). In 2014 there were 11,287 deaths due to prostate cancer, however 84% of men diagnosed with prostate cancer will survive 10 years or more (CRUK, 2016). This paper gives an overview of prostate cancer diagnosis and treatment and the role of general practice nurses (GPNs) in the care of men suspected of having prostate cancer and following treatment.
The UK has one of the highest death rates from asthma in Europe (Global Asthma Network, 2014). Every day three people die from asthma, two-thirds of these deaths are preventable (Asthma UK, n.d.). Why asthma still kills: The National Review of Asthma Deaths. Confidential Enquiry Report (NRAD) was published in 2014 by the Royal College of Physicians (RCP). It is the largest worldwide study looking into why people die from asthma and the first to adopt a UK-wide focus. The NRAD identified that only a fifth of people with asthma are receiving all the basic elements of asthma care which could help them manage their asthma effectively and reduce their risk of experiencing an asthma attack. It provided valuable insights and clear practical recommendations which, if implemented, could improve care and reduce the number of asthma deaths (RCP 2014).
Four million — or one in 16 — adults in the UK have diabetes (whether or not they are aware of it), and this figure is predicted to increase to an estimated five million by 2025 (Diabetes UK, 2015). The majority have type 2 diabetes and the focus of this article will be on the role of general practice nurses (GPNs) in managing type 2 diabetes, although an overview of pre-diabetes, type 1 diabetes, gestational and steroid-induced diabetes will be provided. The author will also discuss the best current dietary advice that GPNs can provide for patients so that they can manage their own diabetes, as well as looking at the support available for GPNs to facilitate self-care in their day-to-day practice.
Atopic eczema is a common dry skin condition, and, as with any dry skin condition, emollients are a fundamental aspect of care. With so much choice there can be uncertainty around which product to use. Choosing one product over another can create confusion for both healthcare professionals and patients. This paper looks at emollients, the products available, how to use them and the current evidence and research relating to emollient use for atopic eczema. The reader is also directed to additional resources to support clinical practice.
The second in this two-part series on migrane focuses on how to treat patients to reduce disability and improve quality of life. Expectation is an important driver to treatment and patients and healthcare professionals should be ‘on the same page’. Unfortunately, this is not always true. Packard (1979) found in his study that doctors thought patients wanted pain relief (96%), medication (68%) and explanation (68%), but what patients actually wanted was explanation (77%), pain relief (69%) and a neurological investigation (31%). Ineffective communication leads to dissatisfaction with care and poor adherence to treatment in headache patients (Cottrell et al, 2002). Therefore, it is essential that patients are involved in the decision-making process when deciding on treatment.
Obesity and its consequences, such as diabetes and cardiovascular disease (CVD), have significant health and NHS cost implications. Relatively small reductions in weight (around 5–10%) have clinically important benefits (Pietrzykowska, 2016), but long-term weight loss maintenance is challenging. Behaviour change interventions have been identified as key for use in weight loss by authorities such as the National Institute for Health and Care Excellence (NICE, 2014). In particular, motivational interviewing (MI) — a form of behaviour change — has been identified as a successful approach to changing health behaviours (Rollnick and Miller, 2013).There is an abundance of evidence showing that just telling people what to do does not work as a way to change patients’ behaviour in order to achieve health gains (NICE, 2014). Furthermore, there is emerging evidence that MI does work and leads to long-term health gains. This article provides an overview of MI to help general practice nurses (GPNs) in their day-to-day practice.
A review of a patient with chronic obstructive pulmonary disease (COPD) by the general practice nurse (GPN) will usually include measures such as spirometry, smoking cessation advice, and a check of inhaler technique to name just a few. However, it also provides an ideal opportunity to assess the patient’s nutritional status and determine the level of risk this may pose. This article explores the need for nutritional assessment, how to stratify risk, how to plan interventions and, importantly, how to incorporate this vital element of care into everyday interactions with this group of patients.
Migraine is a frequent, disabling and distressing disorder, which needs positive diagnosis and management. Some physicians in primary care still have limited awareness of treating this disorder (Minen et al, 2016). This two-part paper aims to help with this, rather than fully investigate the evidence behind recommendations. The literature abounds with reviews freely available if the reader wishes to explore the evidence in more depth. This first paper gives the reader a grounding in migraine to improve confidence in diagnosing and treating migraine, which in turn will improve patient treatment and outcomes
There are many components to consider when performing an annual asthma review. The Quality and Outcomes Framework (QOF) can help by prompting healthcare professionals to include such tasks as inhaler technique, peak flow and the Royal College of Physicians’ three questions (RCP3Q). However, these are only process measures. To perform a review adequately, it is important also to understand the more subtle aspects of asthma management in order to achieve the best outcomes for the patient. The ‘SIMPLES’ approach is one way in which this might be achieved (Ryan et al, 2013).
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