InnovAiT: Education and inspiration for general practice

Chronic rhinosinusitis affects 10.9% of the UK adult population, affecting quality of life and with significant economic cost. The aetiology is unknown, and diagnosis can present challenges. It is characterised by inflammation of the nose and paranasal sinuses that leads to nasal obstruction, discharge, facial pain or pressure and loss of smell, persisting for more than 3 months. Nasal cavity examination aids diagnosis. It is subdivided into chronic rhinosinusitis with and without nasal polyposis. Nasal corticosteroids and saline irrigation make up current baseline management in primary care, with referral to ENT recommended for those with persistent symptoms. Physicians should be alert to persistent unilateral symptoms and the risk of sino-nasal tumours.

Medication-related osteonecrosis of the jaw (MRONJ) is a rare, but well-documented, complication following the administration of anti-resorptive and anti-angiogenic drugs. MRONJ has a negative effect on quality of life, and can result in reduced social contact, pain and masticatory difficulties. Prescription of implicated medication is within the remit of GPs, and thus National Institute for Health and Care Excellence (NICE) guidelines have been published to inform prescribing. Careful consideration of the potential deleterious oral side-effects of these drugs is needed. NICE guidelines on the prescribing of bisphosphonates for osteoporosis acknowledge that osteonecrosis of the jaw was not included in the adverse events when the economic model was assessed. This article provides an overview of MRONJ, highlighting key areas for possible GP intervention when caring for patients at risk of developing MRONJ, and what to do if MRONJ is suspected.

The number of individuals who provide unpaid care across the UK is rising: it currently stands at approximately 8 800 000 people. Some carers can experience a cycle of financial difficulty, isolation, physical and mental ill health. Recommendations for support of this marginalised group have become enshrined in national health policy and GPs have a pivotal role in delivering this help. Involving carers in management plans and providing appropriate support can improve a carer’s wellbeing, and reduce avoidable hospital admissions and residential placements, thus, enabling people to live independent lives for longer. Every caring circumstance is different. In order to provide appropriate, tailored, timely support there needs to be individual identification, assessment and support of carers.

It is well-known that people with an intellectual disability often face a host of health inequalities and co-morbidities. These include childhood obesity, mental health problems, and challenging behaviour. People with an intellectual disability also have reduced life expectancy. GPs are uniquely placed to advocate for and signpost these patients, ensuring they have access to appropriate support. However, it is often unclear what resources are, in reality, both available and beneficial. Here we aim to summarise some of the common inequalities and complexities when working with patients with an intellectual disability and provide an overview of some potentially helpful services.

Primary care plays an important role in sexual healthcare, not least because of rising rates of sexually transmitted infections and a wide variation in local funding for sexual and reproductive healthcare. Sexual health assessment brings some unique challenges. Embarrassment and stigma can hinder assessment. In this article, we provide the basic structure of the sexual history, while reinforcing the skills needed for a sensitive, yet effective, consultation.

As GPs we provide life-long care for patients. This provides an opportunity to sensitively and meaningfully help victims of sexual assault and can have a profound impact on patients, their families, and society. Many patients present late, due to fears of sharing their story and a lack of faith in organisations. This article aims to discuss the impact of sexual assault, and provide a practical approach to identifying and managing sexual assault in primary care. We will discuss the role of the sexual assault referral centres and additional resources available to support patients and doctors.

The stance on solid organ donations in England has changed. In March 2019, the Organ Donation (Deemed Consent) Act became law, with roll-out delayed until spring 2020. It introduces an ‘opt-out’ system, which assumes every adult has agreed to donate their organs unless they register not to do so, amending the previous ‘opt-in’ approach. The RCGP and General Medical Council have long emphasised that doctors be cognisant of the organ donation process and relevant legislation. This paper summarises the rationale behind the Act’s introduction, outlines its provisions, identifies some criticisms, and stresses the importance of raising awareness.