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ObjectiveClinical empathy can enhance patient outcomes. This study examined patients’ perceptions of empathy in primary care consultations delivered by telephone. MethodsA mixed methods study was nested in a larger feasibility study conducted May-October 2020. Adults reporting a UK primary care consultation in the previous 2 weeks completed an online survey. A sample of survey respondents participated in a semi-structured qualitative interview. Interviews were analysed thematically. ResultsSurvey respondents (n=359) rated practitioners as between ‘good’ and ‘very good’ at established patient-reported indicators of clinical empathy. Telephone consultations were rated slightly lower than face-to-face or other consultations. 30 survey respondents were interviewed. Three qualitative themes identified how telephone consultations can shape clinical empathy: setting for an empathic encounter; feeling connected; being acknowledged. ConclusionPrimary care patients typically perceive good levels of clinical empathy in telephone consultations; specific features of telephone consultations may facilitate and/or hinder clinical empathy. Practice ImplicationsTo ensure patients feel listened to, acknowledged and understood, practitioners may need to increase their empathic verbalisations in telephone consultations. By using verbal responses to demonstrate active listening and by clearly describing and/or implementing next steps in management, practitioners may be able to enhance clinical empathy in telephone consultations.

Background Irritable bowel syndrome (IBS) is a common functional bowel disorder that has a considerable impact on patient quality of life and substantial societal and health care resource costs. Current treatments are often ineffective. Tricyclic antidepressants have shown promise in secondary care populations but their effectiveness in a primary care setting remains unclear. Methods ATLANTIS is a randomised, multi-centre, parallel-group, two-arm, double-blind, placebo-controlled trial of low-dose amitriptyline as a second-line treatment for IBS in primary care. Participants will be invited by letter, or recruited opportunistically, from general practices in three regions of England (West Yorkshire, Wessex, and West of England) and screened for eligibility. A total of 518 adult patients with IBS, who are symptomatic despite first-line therapies, will be randomised 1:1 to amitriptyline or identical placebo for 6 months. Treatment will commence at a dose of 10 mg (or one placebo tablet) daily at night, with dose titration up to a maximum of 30 mg at night, depending on side effects and response to treatment. Participant-reported assessments will be conducted at baseline and 3, 6, and 12 months post-randomisation. The primary objective is to determine the effectiveness of amitriptyline, compared with placebo, in improving participant-reported global symptoms of IBS at 6 months (using the IBS Severity Scoring System). Secondary outcomes include relief of IBS symptoms, effect on IBS-associated somatic symptoms (Patient Health Questionnaire-12), anxiety and depression (Hospital Anxiety and Depression Scale), ability to work and participate in other activities (Work and Social Adjustment Scale), acceptability and tolerability of treatment, self-reported health care use, health-related quality of life (EQ-5D-3L), and cost-effectiveness. A nested, qualitative study will explore patient and general practitioner experiences of treatments and trial participation, including acceptability, adherence, unanticipated effects, and implications for wider use of amitriptyline for IBS in primary care. Discussion Determining the clinical and cost-effectiveness of low-dose amitriptyline as a second-line treatment for IBS in primary care will provide robust evidence to inform management decisions. Trial registration ISRCTN ISRCTN48075063 . Registered on 7th June 2019.

BackgroundCoeliac disease (CD) affects approximately 1% of the population, although only a fraction of patients are diagnosed. Our objective was to develop diagnostic prediction models to help decide who should be offered testing for CD in primary care.MethodsLogistic regression models were developed in Clinical Practice Research Datalink (CPRD) GOLD (between Sep 9, 1987 and Apr 4, 2021, n=107,075) and externally validated in CPRD Aurum (between Jan 1, 1995 and Jan 15, 2021, n=227,915), two UK primary care databases, using (and controlling for) 1:4 nested case-control designs. Candidate predictors included symptoms and chronic conditions identified in current guidelines and using a systematic review of the literature. We used elastic-net regression to further refine the models.FindingsThe prediction model included 24, 24, and 21 predictors for children, women, and men, respectively. For children, the strongest predictors were type 1 diabetes, Turner syndrome, IgA deficiency, or first-degree relatives with CD. For women and men, these were anaemia and first-degree relatives. In the development dataset, the models showed good discrimination with a c-statistic of 0·84 (95% CI 0·83–0·84) in children, 0·77 (0·77–0·78) in women, and 0·81 (0·81–0·82) in men. External validation discrimination was lower, potentially because ‘first-degree relative’ was not recorded in the dataset used for validation. Model calibration was poor, tending to overestimate CD risk in all three groups in both datasets.InterpretationThese prediction models could help identify individuals with an increased risk of CD in relatively low prevalence populations such as primary care. Offering a serological test to these patients could increase case finding for CD. However, this involves offering tests to more people than is currently done. Further work is needed in prospective cohorts to refine and confirm the models and assess clinical and cost effectiveness.FundingNational Institute for Health Research Health Technology Assessment Programme (grant number NIHR129020).KeywordsCoeliac disease, prediction model, clinical prediction rule, CPRD.

Introduction Chronic insomnia is common in children. Behavioural interventions are effective.1 A systematic review (pending publication) revealed UK research about primary healthcare (PC) management is limited. Parents seek advice online,2 however, no published research to date has explored parents’ discussions online about PC management. This qualitative study explored (in online discussions) parents’ concerns/expectations about children’s sleep problems, awareness of online, PC, and community management resources, and perceptions of management within PC. Methods Two public online discussion forums were searched for parents’ discussions about children’s sleep problems. Eligible threads were analysed with Braun and Clarke’s reflexive thematic analysis. Results Ninety-three threads were included. Five main themes were developed. Parents had many ‘concerns about children’s sleep problems’ and were emotional/practical support for one another: ‘parents experiences or sharing advice online as a resource’. Parents expressed little regarding PC but had ‘mixed experiences and perceptions of community-based PC professionals’ and ‘limited experiences and perceptions of general practice’. They often discussed ‘other resources for supporting parents with child sleep problems’ (e.g. apps, private sleep consultants). Discussion Parents may have unmet management needs, act as resources for one another, and use non-healthcare resources, however the accuracy of these resources must be explored. The management of chronic insomnia within PC specifically must be further explored. This study/project is funded by the National Institute for Health Research (NIHR) School for Primary Care Research. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. References Mindell JA, Kuhn B, Lewin DS, et al. Behavioral treatment of bedtime problems and night wakings in infants and young children. Sleep 2006; 29(10):1263-76. Hatton REM, Gardani M. Maternal perceptions of advice on sleep in young children: How, what, and when?British Journal of Health Psychology 2018; 23(2):476-95.

Background The prevalence of coeliac disease (CD) is around 1%, but diagnosis is challenged by varied presentation and non-specific symptoms and signs. This study aimed to identify diagnostic indicators that may help identify patients at a higher risk of CD in whom further testing is warranted. Methods International guidance for systematic review methods were followed and the review was registered at PROSPERO (CRD42020170766). Six databases were searched until April 2021. Studies investigating diagnostic indicators, such as symptoms or risk conditions, in people with and without CD were eligible for inclusion. Risk of bias was assessed using the QUADAS-2 tool. Summary sensitivity, specificity, and positive predictive values were estimated for each diagnostic indicator by fitting bivariate random effects meta-analyses. Findings 191 studies reporting on 26 diagnostic indicators were included in the meta-analyses. We found large variation in diagnostic accuracy estimates between studies and most studies were at high risk of bias. We found strong evidence that people with dermatitis herpetiformis, migraine, family history of CD, HLA DQ2/8 risk genotype, anaemia, type 1 diabetes, osteoporosis, or chronic liver disease are more likely than the general population to have CD. Symptoms, psoriasis, epilepsy, inflammatory bowel disease, systemic lupus erythematosus, fractures, type 2 diabetes, and multiple sclerosis showed poor diagnostic ability. A sensitivity analysis revealed a 3-fold higher risk of CD in first-degree relatives of CD patients. Conclusions Targeted testing of individuals with dermatitis herpetiformis, migraine, family history of CD, HLA DQ2/8 risk genotype, anaemia, type 1 diabetes, osteoporosis, or chronic liver disease could improve case-finding for CD, therefore expediting appropriate treatment and reducing adverse consequences. Migraine and chronic liver disease are not yet included as a risk factor in all CD guidelines, but it may be appropriate for these to be added. Future research should establish the diagnostic value of combining indicators.

BackgroundGrowing demand from an ageing population, chronic preventable disease and multimorbidity has resulted in complex health and social care needs requiring more integrated services. Integrating primary care with social services could more efficiently utilise resources, and improve experiences for patients, their families and carers. There is limited evidence on progress including key barriers and drivers of integration to inform large-scale national change.AimTo elicit stakeholder views on drivers and barriers of integrated primary care and social services. and highlight opportunities for successful implementation.Design and settingA qualitative interview study.MethodSemi-structured interviews with maximum variation sampling to capture stakeholder views across services and professions.ResultsThirty-seven interviews were conducted across England including GPs, nurses, social care staff, commissioners, local government, voluntary and private sectors, patients and carers. Drivers of integration included groups of like-minded individuals supported by good leadership, expanded interface roles to bridge gaps between systems and co-location of services. Barriers included structural and interdisciplinary tension between professions, organisational self-interest and challenges in record-sharing.ConclusionsDrivers and barriers to integration identified in other contexts are also present in primary care and social services. Benefits of integration are unlikely to be realised if these are not addressed in the design and execution of new initiatives. Efforts should go beyond local and professional level change to include wider systems and policy-level initiatives. This will support a more systems-wide approach to integrated care reform, which is necessary to meet the complex and growing needs of an ageing multimorbid population.

BackgroundIrritable bowel syndrome (IBS) is common, affecting 10–20% of the adult population worldwide, with many people reporting ongoing symptoms despite first-line therapies. Cognitive behavioural therapy (CBT) is recommended in guidelines for refractory IBS but there is insufficient access to CBT for IBS and uncertainty about whether benefits last in the longer term. Assessing Cognitive behavioural Therapy for IBS (ACTIB) was a large, randomised, controlled trial of two forms of CBT for patients with refractory IBS. ACTIB results showed that, at 12 months, both forms of CBT for IBS were significantly more effective than treatment as usual at reducing IBS symptom severity in adults with refractory IBS. This follow-up study aimed to evaluate 24-month clinical outcomes of participants in the ACTIB trial.MethodsIn the ACTIB three-group, randomised, controlled trial, 558 adults with refractory IBS were randomly allocated to receive either therapist-delivered telephone CBT (telephone-CBT group), web-based CBT with minimal therapist support (web-CBT group), or treatment as usual (TAU group) and were followed up for 12 months. Participants were adults with refractory IBS (clinically significant symptoms for ≥12 months despite being offered first-line therapies), recruited by letter and opportunistically from 74 general practices and three gastroenterology centres in London and the south of England (UK) between May 1, 2014, and March 31, 2016. Primary outcome measures were IBS Symptom Severity Score (IBS-SSS) and Work and Social Adjustment Scale (WSAS), assessed in the intention-to-treat (ITT) population with multiple imputation. This study was a non-prespecified naturalistic follow-up and analysis of the participants of the ACTIB trial at 24 months assessing the same outcomes as the original trial. Outcome measures were completed online by participants or a paper questionnaire was posted, or telephone follow-up undertaken. The ACTIB trial is registered with the International Standard Randomised Controlled Trial Number registry, number ISRCTN44427879.Findings24-month follow-up of outcomes was achieved for 323 (58%) of 558 participants: 119 (64%) of 186 in the telephone-CBT group, 99 (54%) of 185 in the web-CBT group, and 105 (56%) of 187 in the TAU group. At 24 months, mean IBS-SSS was 40·5 points (95% CI 15·0 to 66·0; p=0·002) lower in the telephone-CBT group and 12·9 points (−12·9 to 38·8; p=0·33) lower in the web-CBT group than in the TAU group. The mean WSAS score was 3·1 points (1·3 to 4·9; pInterpretationAt 24-month follow-up, sustained improvements in IBS were seen in both CBT groups compared with TAU, although some previous gains were reduced compared with the 12-month outcomes. IBS-specific CBT has the potential to provide long-term improvement in IBS, achievable within a usual clinical setting. Increasing access to CBT for IBS could achieve long-term patient benefit.FundingUK National Institute for Health Research.

BackgroundNasal balloon autoinflation is an effective, non-surgical treatment for symptomatic children with glue ear, although uptake is variable and evidence about acceptability and feasibility is limited.AimTo explore parent and healthcare professional views and experiences of nasal balloon autoinflation for children with glue ear in primary care.Design and settingQualitative study using semi-structured interviews with a maximum-variety sample of parents, GPs, and practice nurses. The study took place between February 2013 and September 2014.MethodSemi-structured face-to-face and telephone interviews were audiorecorded, transcribed verbatim, and analysed using inductive thematic analysis.ResultsIn all, 14 parents, 31 GPs, and 19 nurses were included in the study. Parents described the nasal balloon as a natural, holistic treatment that was both acceptable and appealing to children. GPs and nurses perceived the method to be a low-cost, low-risk strategy, applicable to the primary care setting. Good instruction and demonstration ensured children mastered the technique and engaged with the treatment, but uncertainties were raised about training provision and potential impact on the GP consultation. Making nasal balloon autoinflation part of a child’s daily routine enhances compliance, but difficulties can arise if children are unwell or refuse to cooperate.ConclusionNasal balloon autoinflation is an acceptable, low-cost treatment option for children with glue ear in primary care. Provision of educational materials and demonstration of the method are likely to promote uptake and compliance. Wider use of the nasal balloon has the potential to enhance early management, and may help to fill the management gap arising from forthcoming changes to care pathways.

Irritable bowel syndrome (IBS) remains one of the most common gastrointestinal disorders seen by clinicians in both primary and secondary care. Since publication of the last British Society of Gastroenterology (BSG) guideline in 2007, substantial advances have been made in understanding its complex pathophysiology, resulting in its re-classification as a disorder of gut-brain interaction, rather than a functional gastrointestinal disorder. Moreover, there has been a considerable amount of new evidence published concerning the diagnosis, investigation and management of IBS. The primary aim of this guideline, commissioned by the BSG, is to review and summarise the current evidence to inform and guide clinical practice, by providing a practical framework for evidence-based management of patients. One of the strengths of this guideline is that the recommendations for treatment are based on evidence derived from a comprehensive search of the medical literature, which was used to inform an update of a series of trial-based and network meta-analyses assessing the efficacy of dietary, pharmacological and psychological therapies in treating IBS. Specific recommendations have been made according to the Grading of Recommendations Assessment, Development and Evaluation system, summarising both the strength of the recommendations and the overall quality of evidence. Finally, this guideline identifies novel treatments that are in development, as well as highlighting areas of unmet need for future research.

OBJECTIVE: To explore primary care practitioners' (PCPs) and patients' priorities and concerns for healthcare interactions for osteoarthritis (OA) in primary care. METHODS: We searched Embase, CINAHL, Medline, PsychInfo (1990 to present) for primary qualitative and mixed methods studies with findings concerning healthcare interactions for OA symptoms. Patient and PCP perceptions were analysed separately then inter-related using a 'line of argument' synthesis. RESULTS: Twenty-six studies reporting qualitative data from 557 patients and 199 PCPs were synthesised. Our findings suggest that therapeutic interactions for OA can be based on discordant priorities and concerns; some patients perceive that PCPs hold negative attitudes about OA and feel their concerns about impact are not appreciated; some PCPs feel patients have misconceptions about prognosis, and hold pessimistic views about outcomes; and both tend to de-prioritise OA within consultations. CONCLUSION: Greater working in partnership could build mutual trust, facilitate tailored provision of information, and foster a shared understanding of OA upon which to build realistic goals for management. PRACTICE IMPLICATIONS: Developing a better shared understanding of OA has the potential to improve the quality of healthcare interactions for both patients and PCPs. The significant impact of OA on everyday life means it should be given higher priority in primary care consultations.

Background Telephone therapist delivered CBT (TCBT) and web-based CBT (WCBT) have been shown to be significantly more clinically effective than treatment as usual (TAU) at reducing IBS symptom severity and impact at 12 months in adults with refractory IBS. In this paper we assess the cost-effectiveness of the interventions. Methods Participants were recruited from 74 general practices and three gastroenterology centres in England. Interventions costs were calculated, and other service use and lost employment measured and costed for one-year post randomisation. Quality-adjusted life years (QALYs) were combined with costs to determine cost-effectiveness of TCBT and WCBT compared to TAU. Results TCBT cost £956 more than TAU (95% CI, £601–£1435) and generated 0.0429 more QALYs. WCBT cost £224 more than TAU (95% CI, − £11 to £448) and produced 0.029 more QALYs. Compared to TAU, TCBT had an incremental cost per QALY of £22,284 while the figure for WCBT was £7724. After multiple imputation these ratios increased to £27,436 and £17,388 respectively. Including lost employment and informal care, TCBT had costs that were on average £866 lower than TAU (95% CI, − £1133 to £2957), and WCBT had costs that were £1028 lower than TAU (95% CI, − £448 to £2580). Conclusions TCBT and WCBT resulted in more QALYs and higher costs than TAU. Complete case analysis suggests both therapies are cost-effective from a healthcare perspective. Imputation for missing data reduces cost-effectiveness but WCTB remained cost-effective. If the reduced societal costs are included both interventions are likely to be more cost-effective. Trial registration ISRCTN44427879 (registered 18.11.13).

Introduction Coeliac disease (CD) is a systemic immune-mediated disorder triggered by gluten in genetically predisposed individuals. CD is diagnosed using a combination of serology tests and endoscopic biopsy of the small intestine. However, because of non-specific symptoms and heterogeneous clinical presentation, diagnosing CD is challenging. Early detection of CD through improved case-finding strategies can improve the response to a gluten-free diet, patients’ quality of life and potentially reduce the risk of complications. However, there is a lack of consensus in which groups may benefit from active case-finding.Methods and analysis We will perform a systematic review to determine the accuracy of diagnostic indicators (such as symptoms and risk factors) for CD in adults and children, and thus can help identify patients who should be offered CD testing. MEDLINE, Embase, Cochrane Library and Web of Science will be searched from 1997 until 2020. Screening will be performed in duplicate. Data extraction will be performed by one and checked by a second reviewer. Disagreements will be resolved through discussion or referral to a third reviewer. We will produce a narrative summary of identified prediction models. Studies, where 2×2 data can be extracted or reconstructed, will be treated as diagnostic accuracy studies, that is, the diagnostic indicators are the index tests and CD serology and/or biopsy is the reference standard. For each diagnostic indicator, we will perform a bivariate random-effects meta-analysis of the sensitivity and specificity.Ethics and dissemination Results will be reported in peer-reviewed journals, academic and public presentations and social media. We will convene an implementation panel to advise on the optimum strategy for enhanced dissemination. We will discuss findings with Coeliac UK to help with dissemination to patients. Ethical approval is not applicable, as this is a systematic review and no research participants will be involved.PROSPERO registration number CRD42020170766.https://creativecommons.org/licenses/by/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.http://dx.doi.org/10.1136/bmjopen-2020-038994

BackgroundIrritable bowel syndrome (IBS) is common and often negatively affects quality of life. Patients frequently perceive medical interventions as inadequate and seek support from other sources, including online discussion forums.AimTo explore online discussion forum topics posted by people with IBS.Design & settingA qualitative study exploring three UK-based online discussion forums.MethodA scoping review identified UK-based discussion forums with high activity and frequent use, which did not require a password/registration to view posts (two IBS-specific and one general health forum). Internal search functions were used to identify and export relevant discussion threads relating to managing IBS. Inductive thematic analysis of exported discussions was undertaken.ResultsAnalysis identified two main overarching themes from 122 relevant discussion threads: 1) sharing information and practical advice about lifestyle changes; and 2) receiving emotional support. The most prevalent topics were lifestyle changes, including diet, using oral preparations (for example, supplements or probiotics), and physical activity. Dietary changes were usually considered positive, and most hopeful for potentially alleviating symptoms. Emotional support was also regularly offered with expressions of empathy, kindness, and gratitude, and a sense of users feeling less alone. Some discussions raised concern around potentially inappropriate symptomatic reassurance, and negative or conflicting advice.ConclusionOnline forums seem, generally, to be a positive experience for those posting, but include potential risks of misinformation. Most posts focus on symptomatic relief through lifestyle change and/or emotional support. Clinicians could gain a better understanding of patients’ ideas, concerns, and expectations of IBS diagnosis and management by asking about patient-acquired online forum information.

This chapter in the Oxford Handbook of General Practice explores haematology in general practice. It covers full blood count and erythrocyte sedimentation rate. It explores diagnosis and initial investigation of anaemia, iron deficiency anaemia, haemoglobinopathies, bleeding and clotting disorders, and anticoagulation. It examines haematological malignancy, acute leukaemia, chronic leukaemia and myeloproliferation, lymphoma, immune deficiency, and allergy.

This chapter in the Oxford Handbook of General Practice explores breast disease in general practice. It covers breast symptoms, benign breast disease, breast cancer screening, risk factors for breast cancer, and diagnosis and care for breast cancer.

This chapter in the Oxford Handbook of General Practice explores ophthalmology in general practice. It covers assessment of the eye, eye trauma, eye pain, papilloedema, and orbital disease. It examines lid disease, blepharitis, tear duct problems, red eye, conjunctivitis, and corneal, scleral and uveal disease. It discusses visual field loss and blindness, sudden loss of vision in one eye, gradual loss of vision, glaucoma, and cataract. It also explores refraction errors, squint, contact lenses, and drugs for the eye.

This chapter in the Oxford Handbook of General Practice explores minor surgery in general practice. It reviews basic techniques, the removal of skin lesions, and commonly performed injections.

This chapter in the Oxford Handbook of General Practice explores dermatology in general practice. It covers skin assessment, treatment of skin conditions, changes in skin colour and eruptions, itching and blistering of the skin, erythema, pigmentation disorder, hair and sweat gland problems, nail changes, and atopic and other eczemas. It discusses ulcers, urticaria, angio-oedema, acne, psoriasis, lichen planus, keratinization disorders, pityriasis, and seborrhoeic warts. It examines sunlight and the skin, benign skin tumours, and skin cancer. It also explores bacterial skin infection, viral skin infection, fungal infection, and infestation.

This chapter in the Oxford Handbook of General Practice describes general practice in the UK, including what general practice is, how to become a general practitioner (GP) in the UK, education in primary care, appraisal and revalidation, working arrangements, career options, good medical practice, the multidisciplinary team, Foundation doctors, stress in general practice, organizations important to general practice, and practice in other countries.

This chapter in the Oxford Handbook of General Practice explores neurology in general practice. It covers reflexes and muscle power, cranial nerve lesions, neuropathy, polyneuropathy, walking problems, and speech problems. It explores transient loss of consciousness, migraine, headache, facial pain, raised intracranial pressure, intracranial bleeds, acute stroke, and prevention of stroke. It discusses Parkinson’s disease, multiple sclerosis, motor neurone disease, and Creutzfeldt–Jakob disease. It also examines spinal cord conditions, epilepsy, muscle disorders, neurological rehabilitation problems, and neurological assessment scales.

This chapter in the Oxford Handbook of General Practice explores palliative care in general practice. It covers pain control and general debility, anorexia, nausea, vomiting, and other gastrointestinal problems. It discusses skin, neurological, orthopaedic, respiratory, haematological, and vascular problems. It also explores problems with mental well-being and examines the last 48 hours and the role of syringe drivers.

This chapter in the Oxford Handbook of General Practice explores emergencies in general practice. It covers emergency patient encounters from warning signs for acute severe illness through to managing a resuscitation attempt outside hospital. It details adult basic life support, paediatric basic life support, the choking adult, the choking child, and the unconscious patient. It explores anaphylaxis, sepsis, meningitis, encephalitis, haemorrhage, shock, chest pain, palpitations, acute coronary syndrome, acute breathlessness, pulmonary embolism, and pneumothorax. It discusses acute asthma in adults and children, acute abdominal pain, fitting and funny turns, endocrine and obstetric emergencies, and resuscitation of the newborn. It explores fractures, head injury, facial injury, scalds, burns, and poisoning. It examines overdose, suicide, disturbed behaviour, compulsory treatment of patients with mental illness, and environmental emergencies.

This chapter in the Oxford Handbook of General Practice explores renal medicine and urology in general practice. It covers laboratory tests, how to estimate renal function, presentation of renal disease, chronic kidney disease, specific kidney diseases, renal stones, and haematuria, bladder, and renal cancer. It explores urinary tract infection, incontinence of urine, aids and appliances, and urinary tract obstruction. It examines benign prostatic hypertrophy, prostate-specific antigen testing, and prostate cancer. It also reviews conditions of the penis and testicular disease.

This chapter in the Oxford Handbook of General Practice explores gynaecology in general practice. It covers the menstrual cycle, premenstrual syndrome, amenorrhoea, menorrhagia, the menopause, and hormone replacement therapy. It discusses pelvic pain, endometriosis and adenomyosis, prolapse, and uterine problems. It also explores ovarian disease, conditions of the cervix, cervical cancer screening, and vaginal and vulval problems.

This chapter in the Oxford Handbook of General Practice explores chronic disease and elderly care in general practice. It examines chronic disease management, multimorbidity, genetics and genomics, and medically unexplained symptoms (MUS). It covers the assessment of pain and neuropathic pain, as well as the principles of pain control and pain-relieving drugs including morphine and other strong opioids. It also reviews all aspects of normal ageing, including falls in older people, prescribing for older people, elderly care and disability management, maintaining independence, and carers.

This chapter in the Oxford Handbook of General Practice explores cardiology and vascular disease (CVD) in general practice. It covers the symptoms and signs of CVD, how to examine the heart and arterial system, cardiac investigation, common electrocardiogram changes, and prevention of CVD. It reviews hypertension and blood pressure measurement, hyperlipidaemia, and angina. It examines myocardial infarction, chronic heart failure, pulmonary hypertension, cor pulmonale, tachycardia, atrial fibrillation, bradycardia, infective endocarditis, rheumatic fever, myocarditis, pericarditis, cardiomyopathy, heart transplant, valve disease and other structural heart abnormalities, as well as aneurysms, chronic peripheral ischaemia, varicose veins, thrombophlebitis, and deep vein thrombosis.

This chapter in the Oxford Handbook of General Practice explores child health in general practice. It covers child health promotion from birth, including the neonatal and 6-week check, neonatal bloodspot screening, screening for hip dysplasia, vision and hearing screening tests, birth trauma, genetic disorders, common problems of small babies, prematurity, and neonatal jaundice. It examines feeding babies, weaning, and developmental milestones. It discusses fever and acute illness in the under 5s, childhood infection, urinary tract infection, congenital heart disease, asthma, constipation, malabsorption, gut atresia, hernias, and intussusception. It explores growth disorders, endocrine problems, funny turns, febrile convulsions, epilepsy, hydrocephalus, neural tube defect, arthritis, dermatology, and cancer. It also discusses behaviour problems, sleep problems, toilet training, poor progress at school, autism, learning disability, adolescence, chronic illness, disability, safeguarding children, and child death.

This chapter in the Oxford Handbook of General Practice explores sexual health and contraception in general practice. It covers assessment of sexual health, vaginal discharge, sexually transmitted infection, chlamydia, trichomonas, gonorrhoea, hepatitis B and C, and HIV infection. It explores contraceptive choices, combined hormonal contraception, progestogen-only contraceptives, and intrauterine contraceptive devices. It discusses teenagers and women over 40, termination of pregnancy, infertility, sexual problems, erectile dysfunction, gender dysphoria, and gender reassignment.

This chapter in the Oxford Handbook of General Practice explores musculoskeletal problems encountered in general practice. It covers symptoms of musculoskeletal disease, neck and low back pain, and problems with the shoulder, elbow, wrist, hand, hip, knee, ankle, and foot. It explores sports medicine and the management of sporting injuries. It examines bone disorders, rickets, osteomalacia, osteoporosis, osteoarthritis, rheumatoid arthritis, spondyloarthropathies, and crystal-induced arthritis. It also discusses connective tissue disease, polymyalgia and giant cell arteritis, tiredness, and chronic fatigue syndrome.

This chapter in the Oxford Handbook of General Practice explores pregnancy in general practice. It covers pre-conception and early pregnancy counselling through to labour and postnatal care. It discusses bleeding in early pregnancy, haemolytic disease and rhesus isoimmunization, antenatal care, health promotion for pregnant women, and advice on location of delivery. It explores screening and medical conditions seen in pregnancy, including specific antenatal screening tests, common symptoms, pruritus and rashes, hypertension, diabetes, and epilepsy. It examines intrauterine growth, multiple pregnancy and malpresentation, and ante- and postpartum haemorrhage. It also discusses common postnatal problems, stillbirth, and neonatal death.

This chapter in the Oxford Handbook of General Practice explores infectious disease in general practice. It covers immunization and symptoms, signs, and notification of infectious disease. It explores sepsis, illness in returning travellers, and immunocompromise. It also examines childhood viral infections, staphylococcal and streptococcal infection, and other bacterial infections.

This chapter in the Oxford Handbook of General Practice explores cancer care in general practice. It covers cancer diagnosis, principles of cancer care, surgery, chemotherapy, immunotherapy, and radiotherapy.

This chapter in the Oxford Handbook of General Practice explores gastrointestinal medicine in general practice. It covers assessment of abdominal pain, vomiting and diarrhoea, gastroenteritis and food poisoning, constipation, and other abdominal symptoms and signs. It examines dyspepsia and Helicobacter pylori, oesophageal conditions, gastro-oesophageal reflux and gastritis, peptic ulceration, and gastro-oesophageal malignancy. It discusses hernias, appendicitis and small bowel disease, colorectal cancer, and other large bowel conditions. It describes anal and perianal conditions, patients with ostomies, malabsorption, faecal incontinence, coeliac disease, inflammatory bowel disease, and irritable bowel syndrome. It also explores jaundice and abnormal liver function, fatty liver disease, hepatitis, liver failure and portal hypertension, gallbladder disease, pancreatitis, and pancreatic tumours.

This chapter in the Oxford Handbook of General Practice discusses all aspects of GP practice management, including GPs as managers, contracts and payments, partnership agreements, practice premises, practice staff, registration of patients, out-of-hours services, patient records, confidentiality, consent, complaints, quality improvement, audit and research, and outcome measures for primary care

This chapter in the Oxford Handbook of General Practice explores ear, nose, and throat (ENT) medicine in general practice. It covers dental and jaw problems, sore throat and tonsillitis, hoarseness and stridor, neck lumps, and salivary gland problems. It examines nasal problems, sinusitis, and rhinitis. It discusses ear pain and external ear problems, otitis media, deafness, tinnitus, and vertigo.

This chapter in the Oxford Handbook of General Practice explores how to give healthy living advice to patients. It looks at prevention and screening, including prevention of travel-related illness. It discusses the effect of diet, obesity, exercise, smoking, insomnia, and alcohol on general health, as well as the management of alcohol misuse and the assessment and management of drug misuse.