More than 80% of men diagnosed with prostate cancer can expect to survive for at least five years. Up to 87% of men with prostate cancer may have unmet supportive care needs. Patients regularly cite psychological and sexual issues as the most significant. Poor functional outcomes after treatment such as incontinence and erectile dysfunction have a major impact on quality of life. The key elements of a survivorship programme are: education, intervention, surveillance and co-ordination of care. Interventions which may improve immediate care include: structured holistic needs assessment and care planning, treatment summaries and cancer care reviews, patient education and support events and advice about, and access to, physical activity schemes. [With external links to the evidence base]

Rosacea is more common in women than men and occurs more frequently in fair-skinned individuals, usually in the middle years of life. It tends to localise to the cheeks, forehead, chin and nose, sometimes showing marked asymmetry. Only very occasionally does it involve areas other than the face. Important distinguishing features from acne are a lack of comedones, absence of involvement of extra-facial areas, and the presence of flushing. Rosacea is a disfiguring condition that can have a major psychosocial impact, and its detrimental effect on emotional health and quality of life is often overlooked.

Deaths from asthma are frequently avoidable, the National Review of Asthma Deaths has confirmed. Key findings from the report include: Almost half the patients (45%) died without seeking medical help or before help could be provided; 10% died within 28 days of discharge from hospital; 21% had attended A&E with asthma in the previous year; and only 23% had a personal asthma action plan. Over-prescription of short-acting bronchodilators and under-prescription of preventer inhalers was common.

In England there has been a sharp increase in the prevalence of overweight and obesity in adults. In 1993 58% of men and 49% of women were classified as overweight or obese compared with 65% and 58% respectively in 2011; 24% of men and 26% of women were classed as obese in 2011. Obesity increases the risk of diabetes, hypertension, coronary heart disease, deep vein thrombosis and pulmonary embolism. It is also associated with an increased risk of certain cancers. Lifestyle weight management programmes should be multicomponent, developed by a multidisciplinary team, and delivered by individuals who have undergone appropriate training. They should focus on long-term weight loss and prevention of weight regain and continue for a minimum of three months.

Contact dermatitis results from skin contact with an exogenous substance. It can be caused by direct contact, airborne particles, vapours or light. Individuals of any age can be affected. The two most common variants are irritant contact dermatitis (ICD) and allergic contact dermatitis (ACD). ICD is more common and has a worse prognosis. ICD is a form of eczema and is induced by direct inflammatory pathways without prior sensitisation. If eczema is recurrent/persistent, or occurs in an individual with no previous history of eczema, contact dermatitis should be considered. If ACD is suspected the patient should be referred to secondary care for patch testing.

Miscarriage is the most common complication of pregnancy. It is defined as a pregnancy failure occurring before the completion of 24 weeks of gestation. It has been estimated that 10 to 15% of all pregnancies end in early spontaneous first trimester miscarriage i.e. before the end of the completed twelfth week of pregnancy. The risk of miscarriage decreases with increasing gestational age, and late miscarriages, from 12 to 24 weeks’ gestation, occur in only 1-4% of cases. While miscarriage is rarely associated with significant health problems, it can cause significant psychological distress to the woman and her partner. [With external links to the current evidence base]

Osteoarthritis remains a clinical diagnosis and importantly radiographic changes and joint symptoms may be poorly correlated. All patients with clinical osteoarthritis should be advised about activity and exercise irrespective of age, comorbidity, pain severity or disability. A rheumatological opinion should be sought if there is doubt regarding the diagnosis or symptoms persist despite treatment. [With external links to the evidence base]

After acute severe brain damage, many people are rendered unconscious or comatose for more than 24 hours. Although a significant number can still recover fully, some will not and a substantial minority remain unconscious for days, weeks or longer. These patients have a prolonged disorder of consciousness. If recovery of awareness has not occurred by six months after hypoxic or hypoglycaemic brain damage and 12 months after most other causes of brain damage, then the patient is very unlikely to recover any awareness and is described as being in a permanent vegetative state.

Seborrhoeic dermatitis usually starts at puberty with a peak incidence at 40 years of age and is more common in males. Patients develop symmetrical, well demarcated, dull or yellowish red patches and plaques with overlying adherent, yellowish greasy scales. Seborrhoeic dermatitis has a distinctive distribution in areas rich in sebaceous glands. Patients presenting with sudden onset severe seborrhoeic dermatitis should be screened for risk factors for HIV.

Bladder cancer is the most frequently diagnosed cancer involving the urinary tract. Delayed diagnosis is associated with high-grade muscle invasive disease which has the potential to progress rapidly, metastasise and is often fatal. Haematuria which is typically intermittent, frank, painless and at times present throughout micturition is the classical and most common presentation of bladder cancer. However, irritative symptoms such as dysuria, urgency, urge incontinence and frequency as well as obstructive symptoms i.e. feeling of incomplete voiding, intermittent stream and straining can also be experienced. [With external links to the current evidence base]

About 20% of all adult emergency admissions are affected by acute kidney injury (AKI) and the mortality rate is almost 25%.  It has been estimated that AKI, excluding cases in the community, causes more than 10,000 preventable deaths a year in England. AKI represents a wide spectrum of injury to the kidneys, not just kidney failure, the vast majority of AKI cases start with an illness in the community. In AKI, loss of kidney function contributes to morbidity and mortality. Patients die from AKI rather than with AKI as a complication of an underlying illness. The definition of AKI now includes any adult with ≥ 26 µmol/L rise in creatinine from baseline over 48 hours or less, or  ≥ 50% rise in creatinine from baseline known or presumed to have occurred over seven days or less.

Alopecia areata is a chronic inflammatory non-scarring condition affecting the hair follicle that leads to hair loss ranging from small well defined patches to complete loss of all body hair. The severity of hair loss at presentation appears to be the strongest predictor of long-term outcome. Individuals with alopecia areata should be referred for dermatological advice if there is diagnostic uncertainty, they have extensive hair loss, they are suffering severe psychological distress or they would like a wig.

Lesions which have a high index of suspicion for melanoma should not be removed in primary care. Patients should be referred urgently to secondary care with a history recording the duration of the lesion, change in size, colour, shape and symptoms. 

Scabies is spread by a mite transferring to the skin surface of an unaffected person, usually by skin to skin contact with an infested person, but occasionally via contaminated bed linen, clothes or towels. Patients with classical scabies usually present with an itchy non-specific rash. Often, the history alone can be virtually diagnostic. An intense itch, affecting all body regions except the head, typically worse at night, appearing to be out of proportion to the physical evidence, with a close contact also itching, should prompt serious consideration of scabies. The crusted variant of scabies may not be itchy. It is characterised by areas of dry, scaly, hyperkeratotic and crusted skin, particularly on the extremities.

Patients with borderline health should consult a physican before travelling to altitude. The physician will need to know the duration of the trip, ascent profile and how much exercise the patient plans to undertake. The presence of comorbid diseases which reduce oxygenation and ventilation should also be taken into account. Every patient must be assessed on an individual basis, there are no clinical investigations which reliably predict outcome at altitude. Patients should not travel to high altitude immediately after an acute coronary syndrome. Most patients with stable coronary artery disease with a sufficiently high exercise capacity at sea level can go as high as 3,000–3,500 m with only a minimally increased risk.

There is a worse prognosis for psychosis and schizophrenia when onset is in childhood or adolescence. Better outcomes in terms of symptoms and social function are associated with a shorter duration of untreated psychosis. The detection of psychotic symptoms in primary care therefore warrants an urgent referral to secondary care mental health services for assessment and treatment. [With external links to the evidence base]

The majority of patients with psoriasis can be managed in primary care, although specialist care may be necessary at some point in up to 60% of cases. Patients with erythrodermic or generalised pustular psoriasis should be referred for a same day dermatological opinion, and if psoriatic arthritis is suspected, early referral for a rheumatological opinion is recommended. Recent guidance from NICE and SIGN will contribute significantly to the care of psoriasis sufferers in both primary and secondary care. [With external links to the evidence base]