Primary Care Guidelines

The video version of this podcast can be found here: https://youtu.be/0yQ_Be-xU6o This video makes reference to guidelines produced by the "National Institute for Health and Care Excellence" in the UK, also referred to as "NICE". Please note that the content on this channel reflects my professional interpretation/summary of the guidance and that I am in no way affiliated with, employed by or funded/sponsored by NICE. My name is Fernando Florido and I am a General Practitioner in the United Kingdom. In this episode, I go through the NICE guideline [NG106] on Chronic Heart Failure in adults, always focusing on what is relevant in Primary Care only. I am not giving medical advice; this video is intended for health care professionals; it is only my summary and my interpretation of the guidelines and you must use your clinical judgement. There is a podcast version of this and other videos that you can access here: Primary Care guidelines podcast: · Redcircle: https://redcircle.com/shows/primary-care-guidelines · Spotify: https://open.spotify.com/show/5BmqS0Ol16oQ7Kr1WYzupK · Apple podcasts: https://podcasts.apple.com/gb/podcast/primary-care-guidelines/id1608821148 There is a YouTube version of this and other videos that you can access here: The Practical GP YouTube Channel: https://youtube.com/@practicalgp?si=ecJGF5QCuMLQ6hrk The resources consulted can be found here: Chronic Heart Failure in adults: diagnosis and management - NICE guideline [NG106]: · https://www.nice.org.uk/guidance/ng106 The visual summary for the diagnosis of chronic heart failure can be found here: · https://www.nice.org.uk/guidance/ng106/resources/chronic-heart-failure-diagnosis-visual-summary-pdf-6663137726 The visual summary for the management of chronic heart failure can be found here: · https://www.nice.org.uk/guidance/ng106/resources/chronic-heart-failure-management-visual-summary-pdf-6663137725 Intro / outro music: Track: Halfway Through — Broke In Summer [Audio Library Release] Music provided by Audio Library Plus Watch: https://youtu.be/aBGk6aJM3IU Free Download / Stream: https://alplus.io/halfway-through Transcript If you are listening to this podcast on YouTube, for a better experience, switch to the video version. The link is in the top right corner of the video and in the episode description. Hello and welcome, I’m Fernando, a GP in the UK. Today we are going to do a quick up-to-date review of the NICE guidelines on the diagnosis and management of chronic heart failure in adults, including the visual summary flowcharts, always focusing on what is relevant in Primary Care only. Right, so let’s jump into it. And we start with the diagnosis. We will take a detailed history and examination and, we will consider the following investigations to exclude other potential conditions: · an ECG · a chest X-ray · blood tests including FBC, renal, liver and thyroid function tests, a lipid profile and HbA1c · urinalysis and · peak flow or spirometry. And, if we suspect heart failure, we will measure the N-terminal pro-B-type natriuretic peptide, which from now on we will refer to as NT‑proBNP High levels of NT‑proBNP carry a poor prognosis. For this reason: · If the levels are very high, i.e. above 2,000 ng/litre or 236 pmol/litre, we will refer them urgently to have specialist assessment and a transthoracic echocardiogram within 2 weeks. · However, if the levels are only moderately high, that is, between 400 and 2,000 ng/litre or 47 to 236 pmol/litre, we will refer them also urgently but to be seen within 6 weeks. We also need to be aware that: · an NT‑proBNP level less than 400 ng/litre or 47 pmol/litre in an untreated person makes heart failure less likely so we should consider alternative causes and refer if in doubt. · the NT‑proBNP level does not differentiate between heart failure with reduced ejection fraction and heart failure with preserved ejection fraction. Let’s remember that heart...

The video version of this podcast can be found here: https://youtu.be/Pi7cBcov2fI This video makes reference to guidelines produced by the "National Institute for Health and Care Excellence" in the UK, also referred to as "NICE". Please note that the content on this channel reflects my professional interpretation/summary of the guidance and that I am in no way affiliated with, employed by or funded/sponsored by NICE. My name is Fernando Florido and I am a General Practitioner in the United Kingdom. In this episode, I go through a thorough review of the NICE guideline [NG136] on Hypertension in adults, with a series of multiple-choice questions. Each question is paired with quotation, aiming to clarify key concepts and enhance understanding. This informative segment is created to support continuous learning always focusing on what is relevant in Primary Care only. I am not giving medical advice; this video is intended for health care professionals; it is only my summary and my interpretation of the guidelines and you must use your clinical judgement. There is a podcast version of this and other videos that you can access here: Primary Care guidelines podcast: · Redcircle: https://redcircle.com/shows/primary-care-guidelines · Spotify: https://open.spotify.com/show/5BmqS0Ol16oQ7Kr1WYzupK · Apple podcasts: https://podcasts.apple.com/gb/podcast/primary-care-guidelines/id1608821148 There is a YouTube version of this and other videos that you can access here: The Practical GP YouTube Channel: https://youtube.com/@practicalgp?si=ecJGF5QCuMLQ6hrk The resources consulted can be found here: Hypertension in adults: diagnosis and management - NICE guideline [NG136]: · https://www.nice.org.uk/guidance/ng136 The NICE hypertension flowcharts can be found here: · Website: https://www.nice.org.uk/guidance/ng136/resources/visual-summary-pdf-6899919517 The Clinic BP targets tables can be downloaded here: · https://1drv.ms/b/s!AiVFJ_Uoigq0mFtrsXeUGOB58DKE?e=J7filE Intro / outro music: Track: Halfway Through — Broke In Summer [Audio Library Release] Music provided by Audio Library Plus Watch: https://youtu.be/aBGk6aJM3IU Free Download / Stream: https://alplus.io/halfway-through Transcript If you are listening to this podcast on YouTube, for a better experience, switch to the video version. The link is in the top right corner of the video and in the episode description. Hello and welcome, I’m Fernando, a GP in the UK. Today we are going to do a revision of the NICE guidelines on hypertension, including the changes introduced in November 2023, always focusing on what is relevant in Primary Care only. I have created a number of multiple-choice questions, many of them presented as clinical scenarios, which will help you revise, test your knowledge and also assist you in remembering the facts more effectively. The range of questions varies from fairly easy and straightforward ones to others which are more complex and require more thinking. After each question and their four options, you will get the correct answer paired with a guiding quotation from the NICE guideline. Please note that the correct answers only reflect the strict use of the guideline, not a flexible clinical judgement. Finally, I am going to delegate the reading of this section to an automated voice. I hope that you find it useful. Good luck with your self-test! Sarah, a 50-year-old woman with type 2 diabetes and hypertension, is starting step 1 antihypertensive treatment. What should be offered to her? Calcium-channel blocker Thiazide-like diuretic ACE inhibitor or ARB Beta-blocker The correct answer is: ACE inhibitor or ARB NICE quote: Offer an ACE inhibitor or an ARB to adults starting step 1 antihypertensive treatment who: have type 2 diabetes and are of any age or family origin What is recommended regarding lifestyle advice for people with suspected or diagnosed hypertension? Offer magnesium, and potassium...

The video version of this podcast can be found here: https://youtu.be/dVpfeUxt8K8 This episode makes reference to guidelines produced by the "National Institute for Health and Care Excellence" in the UK, also referred to as "NICE". The content on this channel reflects my professional interpretation/summary of the guidance and I am in no way affiliated with, employed by or funded/sponsored by NICE. My name is Fernando Florido and I am a General Practitioner in the United Kingdom. In this episode I will go through new and updated guidelines published in April 2024 by the National Institute for Health and Care Excellence (NICE), focusing on those that are relevant to Primary Care only. I am not giving medical advice; this video is intended for health care professionals, it is only my summary and my interpretation of the guidelines and you must use your clinical judgement. There is a podcast version of this and other videos that you can access here: Primary Care guidelines podcast: · Redcircle: https://redcircle.com/shows/primary-care-guidelines · Spotify: https://open.spotify.com/show/5BmqS0Ol16oQ7Kr1WYzupK · Apple podcasts: https://podcasts.apple.com/gb/podcast/primary-care-guidelines/id1608821148 There is a YouTube version of this and other videos that you can access here: The Practical GP YouTube Channel: https://youtube.com/@practicalgp?si=ecJGF5QCuMLQ6hrk The Full NICE News bulletin for April 2024 can be found here: · https://www.nice.org.uk/guidance/published?from=2024-04-01&to=2024-04-30&ndt=Guidance&ndt=Quality+standard The links to the guidance covered can be found here: Endometriosis: diagnosis and management- NICE guideline [NG743] can be found here: · https://www.nice.org.uk/guidance/ng73 Final draft guidance on Atogepant for preventing migraine [ID5090] | can be found here: · https://www.nice.org.uk/guidance/indevelopment/gid-ta10992/documents Intro / outro music: Track: Halfway Through — Broke In Summer [Audio Library Release] Music provided by Audio Library Plus Watch: https://youtu.be/aBGk6aJM3IU Free Download / Stream: https://alplus.io/halfway-through Transcript If you are listening to this podcast on YouTube, for a better experience, switch to the video version. The link is in the top right corner of the video and in the episode description. Hello and welcome, I am Fernando, a GP in the UK. Today, we are looking at the NICE updates published in April 2024, focusing on what is relevant in Primary Care only. And in April we have had very little new guidance relevant to primary care, in fact, there was only one guideline containing relevant information for us, the guideline on endometriosis. But, to make up for it, we also have the NICE final draft guidance on atogepant for migraine prophylaxis, which I will cover briefly after the endometriosis update. Right, let’s jump into it. So, let’s start with the guideline on Endometriosis. The management is normally guided by secondary care but this guideline also includes recommendations relevant to primary care such as the clinical presentation, diagnosis and referral recommendations. And let’s start with the clinical presentation. NICE says that we should suspect endometriosis in women (including those under 17) if they have at least 1 of the following: · chronic pelvic pain · dysmenorrhoea · deep pain during or after sexual intercourse and · either period-related or cyclical gastrointestinal and urinary symptoms, in particular, painful bowel movements, haematuria or dysuria We will offer an abdominal examination to exclude masses and, if appropriate, a pelvic and vaginal examination too. What investigations should we organise? Well, we can do a transvaginal ultrasound, which can identify signs of endometriosis. If a transvaginal scan is not appropriate, we will do a transabdominal pelvic ultrasound scan. We will not use serum CA125 to diagnose endometriosis but if it is available we must be aware that: · a...

The video version of this podcast can be found here: https://youtu.be/8dYGalK25os This video makes reference to guidelines produced by the "National Institute for Health and Care Excellence" in the UK, also referred to as "NICE". Please note that the content on this channel reflects my professional interpretation/summary of the guidance and that I am in no way affiliated with, employed by or funded/sponsored by NICE. My name is Fernando Florido and I am a General Practitioner in the United Kingdom. In this episode, I go through the concept of Hypertensive Urgency as opposed to Hypertensive Emergency. I am not giving medical advice; this video is intended for health care professionals; it is only my summary and my interpretation of the guidelines and you must use your clinical judgement. There is a podcast version of this and other videos that you can access here: Primary Care guidelines podcast: · Redcircle: https://redcircle.com/shows/primary-care-guidelines · Spotify: https://open.spotify.com/show/5BmqS0Ol16oQ7Kr1WYzupK · Apple podcasts: https://podcasts.apple.com/gb/podcast/primary-care-guidelines/id1608821148 There is a YouTube version of this and other videos that you can access here: The Practical GP YouTube Channel: https://youtube.com/@practicalgp?si=ecJGF5QCuMLQ6hrk The resources consulted can be found here: Hypertension in adults: diagnosis and management - NICE guideline [NG136]: · https://www.nice.org.uk/guidance/ng136 The NICE hypertension flowcharts can be found here: · Website: https://www.nice.org.uk/guidance/ng136/resources/visual-summary-pdf-6899919517 The Clinic BP targets tables can be downloaded here: · https://1drv.ms/b/s!AiVFJ_Uoigq0mFtrsXeUGOB58DKE?e=J7filE Worcestershire Acute Hospitals NHS Trust guideline on the Management of Hypertensive crises: · https://www.bing.com/ck/a?!&&p=9b5fdeea73ebb791JmltdHM9MTcxMzU3MTIwMCZpZ3VpZD0xODRhNTBkMS0xZGExLTYzZWItMjMyYi00NGMwMWNhNzYyYjMmaW5zaWQ9NTIwOA&ptn=3&ver=2&hsh=3&fclid=184a50d1-1da1-63eb-232b-44c01ca762b3&psq=Worcestershire+Acute+Hospitals+NHS+Trust+guidelines+hypertensive+crises&u=a1aHR0cHM6Ly9hcHBzLndvcmNzYWN1dGUubmhzLnVrL0tleURvY3VtZW50UG9ydGFsL0hvbWUvRG93bmxvYWRGaWxlLzM3NDk&ntb=1 The Worcestershire Acute Hospitals NHS Trust Hypertensive crisis flowchart can be downloaded here: · https://1drv.ms/b/s!AiVFJ_Uoigq0mRX6no6c5m3ddfEC?e=aPVQ67 NICBH PUBMED · https://www.ncbi.nlm.nih.gov/books/NBK513351/ Slides MRCP · https://www.bing.com/ck/a?!&&p=695818f027015fbaJmltdHM9MTcxMzU3MTIwMCZpZ3VpZD0xODRhNTBkMS0xZGExLTYzZWItMjMyYi00NGMwMWNhNzYyYjMmaW5zaWQ9NTIxMQ&ptn=3&ver=2&hsh=3&fclid=184a50d1-1da1-63eb-232b-44c01ca762b3&psq=adrian+stanley+hypertensive+urgency&u=a1aHR0cHM6Ly93d3cucmNwbG9uZG9uLmFjLnVrL2ZpbGUvMjk2Ny9kb3dubG9hZA&ntb=1 NEJM article: Acute severe hypertension: · https://www.nejm.org/doi/full/10.1056/NEJMcp1901117 Approach to HTN urgency in primary care setting · https://journals.lww.com/tnpj/Fulltext/2021/10000/Approach_to_a_patient_with_hypertensive_urgency_in.13.aspx Intro / outro music: Track: Halfway Through — Broke In Summer [Audio Library Release] Music provided by Audio Library Plus Watch: https://youtu.be/aBGk6aJM3IU Free Download / Stream: https://alplus.io/halfway-through Transcript If you are listening to this podcast on YouTube, for a better experience, switch to the video version. The link is in the top right corner of the video and in the episode description. Hello and welcome, I’m Fernando, a GP in the UK. Today I will touch on a subject which is not really covered by NICE, which is the concept of hypertensive urgency, as opposed to hypertensive emergency. It is an interesting subject which we are going to illustrate with a practical case, so make sure that you stick around till then. For this I have consulted a number of medical publications and guidelines and the links are in the episode description. Right, so let’s jump into it. So, let’s start with some definitions. ·...

The video version of this podcast can be found here: https://youtu.be/wjIbwy9SdAQ?si=hBe18dtUf_rPtRc8 This video makes reference to guidelines produced by the "National Institute for Health and Care Excellence" in the UK, also referred to as "NICE". Please note that the content on this channel reflects my professional interpretation/summary of the guidance and that I am in no way affiliated with, employed by or funded/sponsored by NICE. My name is Fernando Florido and I am a General Practitioner in the United Kingdom. In this episode, I go through the NICE guideline [NG136] on Hypertension in adults, always focusing on what is relevant in Primary Care only. I am not giving medical advice; this video is intended for health care professionals; it is only my summary and my interpretation of the guidelines and you must use your clinical judgement. There is a podcast version of this and other videos that you can access here: Primary Care guidelines podcast: · Redcircle: https://redcircle.com/shows/primary-care-guidelines · Spotify: https://open.spotify.com/show/5BmqS0Ol16oQ7Kr1WYzupK · Apple podcasts: https://podcasts.apple.com/gb/podcast/primary-care-guidelines/id1608821148 There is a YouTube version of this and other videos that you can access here: The Practical GP YouTube Channel: https://youtube.com/@practicalgp?si=ecJGF5QCuMLQ6hrk The resources consulted can be found here: Hypertension in adults: diagnosis and management - NICE guideline [NG136]: · https://www.nice.org.uk/guidance/ng136 Chronic kidney disease: assessment and management - NICE guideline [NG203]: · https://www.nice.org.uk/guidance/ng203 The NICE hypertension flowcharts can be found here: · Website: https://www.nice.org.uk/guidance/ng136/resources/visual-summary-pdf-6899919517 The Full NICE guideline Hypertension in pregnancy: diagnosis and management [NG133] can be found at: · https://www.nice.org.uk/guidance/ng133/chapter/Recommendations The Clinic BP targets tables can be downloaded here: · https://1drv.ms/b/s!AiVFJ_Uoigq0mFtrsXeUGOB58DKE?e=J7filE Intro / outro music: Track: Halfway Through — Broke In Summer [Audio Library Release] Music provided by Audio Library Plus Watch: https://youtu.be/aBGk6aJM3IU Free Download / Stream: https://alplus.io/halfway-through Transcript If you are listening to this podcast on YouTube, for a better experience, switch to the video version. The link is in the top right corner of the video and in the episode description. Hello and welcome, I’m Fernando, a GP in the UK. Today we are going to do an up-to-date review of the NICE guidelines on hypertension, including the changes introduced in November 2023, always focusing on what is relevant in Primary Care only. Right, so let’s jump into it. First, this guideline does not cover specific recommendations in CKD, type 1 diabetes, or pregnancy. However, it does cover type 2 diabetes, given that the management of hypertension in type 2 diabetes is no different than in the general population. Let’s just remind ourselves that, when checking the BP, we should always palpate the pulse first and, if there is pulse irregularity, we should measure the BP manually, because automated devices are not accurate when the pulse is irregular like in AF. If there are symptoms of postural hypotension, like falls or dizziness: · We will measure their BP while lying on their back (although we can consider a seated position, if inconvenient) · And we will measure their BP again after standing for at least 1 minute. If the systolic BP falls by 20 or more, or their diastolic BP by 10 or more: · we will consider the causes, and review their medication · we will manage the risk of falls · we will check future BP readings with the patient standing and · we will refer if necessary Also, in order to diagnose hypertension, we will measure the BP in both arms: · If the difference is more than 15 mmHg, more than once, we will measure subsequent BPs in the arm with...

The video version of this podcast can be found here: https://youtu.be/41MH-Z-tcf8 This episode makes reference to guidelines produced by the "National Institute for Health and Care Excellence" in the UK, also referred to as "NICE". The content on this channel reflects my professional interpretation/summary of the guidance and I am in no way affiliated with, employed by or funded/sponsored by NICE. My name is Fernando Florido and I am a General Practitioner in the United Kingdom. In this episode I will go through new and updated guidelines published in March 2024 by the National Institute for Health and Care Excellence (NICE), focusing on those that are relevant to Primary Care only. I am not giving medical advice; this video is intended for health care professionals, it is only my summary and my interpretation of the guidelines and you must use your clinical judgement. There is a podcast version of this and other videos that you can access here: Primary Care guidelines podcast: · Redcircle: https://redcircle.com/shows/primary-care-guidelines · Spotify: https://open.spotify.com/show/5BmqS0Ol16oQ7Kr1WYzupK · Apple podcasts: https://podcasts.apple.com/gb/podcast/primary-care-guidelines/id1608821148 There is a YouTube version of this and other videos that you can access here: The Practical GP YouTube Channel: https://youtube.com/@practicalgp?si=ecJGF5QCuMLQ6hrk The Full NICE News bulletin for March 2024 can be found here: · https://www.nice.org.uk/guidance/published?from=2024-03-01&to=2024-03-31&ndt=Guidance&ndt=Quality+standard The links to the guidance covered can be found here: Ovarian cancer: identifying and managing familial and genetic risk- NICE guideline [NG241] can be found here: · https://www.nice.org.uk/guidance/ng241 Meningitis (bacterial) and meningococcal disease: recognition, diagnosis and management- NICE guideline [NG240] can be found here: · https://www.nice.org.uk/guidance/ng240 Vitamin B12 deficiency in over 16s: diagnosis and management- NICE guideline [NG239] can be found here: · https://www.nice.org.uk/guidance/ng239 My summary of meningitis and meningococcal disease symptoms can be found here: · https://1drv.ms/b/s!AiVFJ_Uoigq0mRE17SGM9XfnH-0n?e=lx7zVg 2-page visual summary on ongoing care and follow up options for oral and intramuscular vitamin B12 replacement: · https://www.nice.org.uk/guidance/ng239/resources/visual-summary-ongoing-care-and-followup-for-vitamin-b12-replacement-pdf-13315996909 Intro / outro music: Track: Halfway Through — Broke In Summer [Audio Library Release] Music provided by Audio Library Plus Watch: https://youtu.be/aBGk6aJM3IU Free Download / Stream: https://alplus.io/halfway-through Transcript If you are listening to this podcast on YouTube, for a better experience, switch to the video version. The link is in the top right corner of the video and in the episode description. Hello and welcome, I am Fernando, a GP in the UK. Today, we are looking at the NICE updates published in March 2024, focusing on what is relevant in Primary Care only. And in March we have had a feast of new guidance. Not because there have been many updates but because of three completely new guidelines that have been published for the very first time. We will be covering managing genetic risk of ovarian cancer, bacterial meningitis and meningococcal disease and the eagerly awaited vitamin B12 deficiency guideline. Right, let’s jump into it. So, let’s start with the guideline on identifying and managing genetic risk of ovarian cancer saying that these recommendations are for anyone who has a familial or genetic risk of ovarian cancer. This includes people with both female and male reproductive organs because although people with male reproductive organs cannot develop ovarian cancer, they can pass the risk on to their children, and may be at risk of developing other cancers. So, the brief summary for us is that, in primary care, we should refer people for genetic testing if...

The video version of this podcast can be found here: https://youtu.be/SaizjWg7Fng?si=5067IvQ3Uf9yFVJX This episode reviews common abnormal urine tests based on published medical information as well as guidance by NICE and a number of NHS organisations in the UK. Please note that the content on this channel reflects my professional interpretation/summary of the guidance and that I am in no way affiliated with, employed by or funded/sponsored by them. My name is Fernando Florido and I am a General Practitioner in the United Kingdom. In this episode, I go through the interpretation and initial management of invisible haematuria, sterile pyuria and proteinuria, always focusing on what is relevant in Primary Care only. I am not giving medical advice; this video is intended for health care professionals; it is only my summary and my interpretation of the information consulted. You must always use your clinical judgement. There is a podcast version of this and other videos that you can access here: Primary Care guidelines podcast: · Redcircle: https://redcircle.com/shows/primary-care-guidelines · Spotify: https://open.spotify.com/show/5BmqS0Ol16oQ7Kr1WYzupK · Apple podcasts: https://podcasts.apple.com/gb/podcast/primary-care-guidelines/id1608821148 There is a YouTube version of this and other videos that you can access here: The Practical GP YouTube Channel: https://youtube.com/@practicalgp?si=ecJGF5QCuMLQ6hrk My summary guide / flowchart can be downloaded here: · https://1drv.ms/b/s!AiVFJ_Uoigq0mRCSWQ0Shpin4PS9?e=F5moTm The resources consulted can be found here: Suspected cancer: recognition and referral -NICE guideline [NG12] – urological cancers: · https://www.nice.org.uk/guidance/ng12/chapter/Recommendations-organised-by-site-of-cancer#urological-cancers Chronic kidney disease: assessment and management - NICE guideline [NG203]: · https://www.nice.org.uk/guidance/ng203 Joint consensus statement on the initial assessment of haematuria prepared on behalf of the Renal Association and British Association of Urological Surgeons: · https://www.baus.org.uk/_userfiles/pages/files/Publications/haematuria_consensus_guidelines_July_2008.pdf Assessment and management of non-visible haematuria in primary care BMJ article- BMJ 2009;338:a3021: · https://www.bmj.com/content/338/bmj.a3021 · https://www.bmj.com/bmj/section-pdf/186116?path=/bmj/338/7688/Clinical_Review.full.pdf North Central London Haematuria clinical pathway PDF: · https://gps.northcentrallondon.icb.nhs.uk/pathways/haematuria Investigating painless haematuria BMJ article - BMJ 2008;337:a260: · https://www.bmj.com/content/337/bmj.a260 South East London Urology Adult Primary Care Guidelines: · https://www.bing.com/ck/a?!&&p=c2f49d786a34ebffJmltdHM9MTcxMDgwNjQwMCZpZ3VpZD0xZGNjZTJiMC05M2Y4LTYzZTUtMzhkYi1mNmY3OTJjNDYyYzYmaW5zaWQ9NTE4NQ&ptn=3&ver=2&hsh=3&fclid=1dcce2b0-93f8-63e5-38db-f6f792c462c6&u=a1aHR0cHM6Ly9zZWxvbmRvbmNjZy5uaHMudWsvd3AtY29udGVudC91cGxvYWRzL2RsbV91cGxvYWRzLzIwMjMvMTEvSEczMDM3LVNFTC1Vcm9sb2d5LUd1aWRlbGluZXMtRklOQUwtTm92LTIwMjMtMS5wZGY&ntb=1 Intro / outro music: Track: Halfway Through — Broke In Summer [Audio Library Release] Music provided by Audio Library Plus Watch: https://youtu.be/aBGk6aJM3IU Free Download / Stream: https://alplus.io/halfway-through Transcript If you are listening to this podcast on YouTube, for a better experience, switch to the video version. The link is in the top right corner of the video and in the episode description. Hello and welcome, I’m Fernando, a GP in the UK. Today we are going to go through the interpretation and initial management of non-visible haematuria, always focusing on what is relevant in Primary Care only. And for that I will summarise a variety of guidelines and medical publications including NICE guidance and advice provided by a number of NHS bodies in the UK. The links to them are in the episode description and I recommend having a look at them. There you will also be able to find the...

Podcast description The video version of this podcast can be found here: https://youtu.be/IaId_nNbO-c?si=0FF7A5J7iPxocdBd This episode refers to guidelines on the management of abnormal liver function tests by the British Society of Gastroenterology and a number of NHS organisations in the UK. Please note that the content on this channel reflects my professional interpretation/summary of the guidance and that I am in no way affiliated with, employed by or funded/sponsored by them. My name is Fernando Florido and I am a General Practitioner in the United Kingdom. In this episode, I go through the interpretation of an abnormal liver function tests, always focusing on what is relevant in Primary Care only. I am not giving medical advice; this video is intended for health care professionals; it is only my summary and my interpretation of the information consulted. You must always use your clinical judgement. There is a podcast version of this and other videos that you can access here: Primary Care guidelines podcast: · Redcircle: https://redcircle.com/shows/primary-care-guidelines · Spotify: https://open.spotify.com/show/5BmqS0Ol16oQ7Kr1WYzupK · Apple podcasts: https://podcasts.apple.com/gb/podcast/primary-care-guidelines/id1608821148 There is a YouTube version of this and other videos that you can access here: https://youtube.com/@practicalgp?si=ecJGF5QCuMLQ6hrk My summary guide can be downloaded here: · https://1drv.ms/b/s!AiVFJ_Uoigq0mQ8MRxaNYnA1_pzh?e=H2U7rS The resources consulted can be found here: BSG- British Society of Gastroenterology: · bsg.org.uk/clinical-resource/guidelines-on-abnormal-liver-blood-tests · Guidelines on the management of abnormal liver blood tests (bsg.org.uk) o First published on: o BMJ article: o Guidelines on the management of abnormal liver blood tests | Gut (bmj.com) Southeast London pathway: · Microsoft Word - Abnormal liver function test pathway-explanatory.docx (selondonccg.nhs.uk) North and East Devon pathway: · Management of Abnormal LFTs in Asymptomatic Adults - North & East (devonformularyguidance.nhs.uk) North Bristol · https://www.nbt.nhs.uk/sites/default/files/Investigation%20of%20Adult%20Patients%20with%20Abnormal%20LFT%20in%20Primary%20Care.pdf West Hampshire: · Liver Blood Test Pathway | GP Portal (westhampshireccg.nhs.uk) Medscape: · Liver Blood Tests: How to Interpret Abnormal Results (medscape.co.uk) Intro / outro music: Track: Halfway Through — Broke In Summer [Audio Library Release] https://youtu.be/aBGk6aJM3IUhttps://alplus.io/halfway-through Transcript If you are listening to this podcast on YouTube, for a better experience, switch to the video version. The link is in the top right corner of the video and in the episode description. Hello and welcome, I’m Fernando, a GP in the UK. Today we are going to go through the interpretation of abnormal liver function tests or LFTs, including initial follow up management, always focusing on what is relevant in Primary Care only. And for that I will summarise the British Society of Gastroenterology guidelines on LFTs. They were first published in the BMJ and the relevant links are in the episode description. Although the full guideline covers both adults and children, in today’s episode I will be focusing only on adults. At the end, I will also tell you how to access my summary of the recommendations, which will be based not only on the BSG but also on a number of NHS bodies in the UK. The links to them are in the episode description and it’s worth having a look as they have flowcharts and other information that you may find useful. Right, there is a lot of information to cover, so let’s jump into it. The three the most common causes of liver disease are alcohol-related liver disease, non-alcoholic fatty liver disease and viral hepatitis, although autoimmune liver disease is also a significant cause. Liver disease develops silently and at earlier stages liver enzymes may be normal. If they are...

The video version of this podcast can be found here: https://youtu.be/XZxllA7iSIk?si=2d9kxQLJOY6ER0iu This episode makes reference to guidelines produced by the "National Institute for Health and Care Excellence" in the UK, also referred to as "NICE". The content on this channel reflects my professional interpretation/summary of the guidance and I am in no way affiliated with, employed by or funded/sponsored by NICE. My name is Fernando Florido and I am a General Practitioner in the United Kingdom. In this episode I will go through new and updated guidelines published during 2023 by the National Institute for Health and Care Excellence (NICE), focusing on those that are relevant to Primary Care only. I am not giving medical advice; this video is intended for health care professionals, it is only my summary and my interpretation of the guidelines and you must use your clinical judgement. The Clinic BP targets flowchart can be downloaded here: · https://1drv.ms/b/s!AiVFJ_Uoigq0mFp2iUfq8rimJSmo?e=BnJaCD The Clinic BP targets tables can be downloaded here: · https://1drv.ms/b/s!AiVFJ_Uoigq0mFtrsXeUGOB58DKE?e=J7filE There is a podcast version of this and other videos that you can access here: Primary Care guidelines podcast: · Redcircle: https://redcircle.com/shows/primary-care-guidelines · Spotify: https://open.spotify.com/show/5BmqS0Ol16oQ7Kr1WYzupK · Apple podcasts: https://podcasts.apple.com/gb/podcast/primary-care-guidelines/id1608821148 There is a YouTube version of this and other videos that you can access here: The Practical GP YouTube Channel: https://youtube.com/@practicalgp?si=ecJGF5QCuMLQ6hrk Intro / outro music: Track: Halfway Through — Broke In Summer [Audio Library Release] Music provided by Audio Library Plus Watch: https://youtu.be/aBGk6aJM3IU Free Download / Stream: https://alplus.io/halfway-through The Full NICE News bulletin for January 2024 can be found here: · https://www.nice.org.uk/guidance/published?from=2024-02-01&to=2024-02-29&ndt=Guidance&ndt=Quality+standard The links to the update guidance covered can be found here: The guidance on chronic heart failure in adults can be found here: · https://www.nice.org.uk/guidance/qs9 The guidance on UTI in adults can be found here: · https://www.nice.org.uk/guidance/qs90 The guidance on Type 1 diabetes in adults can be found here: · https://www.nice.org.uk/guidance/qs208 The guidance on Type 2 diabetes in adults can be found here: · https://www.nice.org.uk/guidance/qs209 The full NICE guideline on “Hypertension in pregnancy: diagnosis and management” can be found here: · https://www.nice.org.uk/guidance/ng133 Dapagliflozin for treating chronic heart failure with preserved or mildly reduced ejection fraction: · https://www.nice.org.uk/guidance/ta902 Empagliflozin for treating chronic heart failure with preserved or mildly reduced ejection fraction: · https://www.nice.org.uk/guidance/ta929 Obesity in adults: identification, assessment and management · https://www.nice.org.uk/guidance/cg189 Quantitative faecal immunochemical testing to guide colorectal cancer pathway referral in primary care · https://www.nice.org.uk/guidance/dg56 Joint guidelines from ACPGBI and BSG can be found at: · https://www.acpgbi.org.uk/resources/1075/fit_in_patients_with_signs_or_symptoms_of_suspected_crc_a_joint_guideline_from_acpgbi_and_bsg Chronic obstructive pulmonary disease in adults: quality standard · https://www.nice.org.uk/guidance/qs10 Rimegepant for treating migraine: · https://www.nice.org.uk/guidance/ta919 Transient loss of consciousness ('blackouts') in over 16s: · https://www.nice.org.uk/guidance/cg109 Bipolar disorder: assessment and management: · https://www.nice.org.uk/guidance/cg185 Cardiovascular disease: risk assessment and reduction, including lipid modification: · https://www.nice.org.uk/guidance/ng238 Transcript If you are listening to this podcast on YouTube, for a better experience, switch to the video version....

The video version of this episode can be found here: https://youtu.be/t-wXLOAr8ik?si=TR3eNXpNPlBP3NCsMy summary of the guidance consulted can be found here: · https://1drv.ms/b/s!AiVFJ_Uoigq0mQ4ZjYGRH1wkGBdc?e=Zuxx84 This episode refers to guidelines produced by a number of organisations. Please note that the content reflects my professional interpretation/summary of the guidance and that I am in no way affiliated with, employed by or funded/sponsored by any of them. My name is Fernando Florido and I am a General Practitioner in the United Kingdom. In this episode, I go through the interpretation of an abnormal full blood count, always focusing on what is relevant in Primary Care only. I am not giving medical advice; this video is intended for health care professionals; it is only my summary and my interpretation of the information consulted. You must always use your clinical judgement. There is a podcast version of this and other videos that you can access here: Primary Care guidelines podcast: · Redcircle: https://redcircle.com/shows/primary-care-guidelines · Spotify: https://open.spotify.com/show/5BmqS0Ol16oQ7Kr1WYzupK · Apple podcasts: https://podcasts.apple.com/gb/podcast/primary-care-guidelines/id1608821148 There is a YouTube version of this and other videos that you can access here: The Practical GP YouTube Channel: https://youtube.com/@practicalgp?si=ecJGF5QCuMLQ6hrk The resources consulted can be found here: · Camden CCG guidance: 1456246258-2f3891e610beaa6533f2c0ad7866e776.pdf(Review) - Adobe cloud storage · Manchester Adult anaemia guide: https://acrobat.adobe.com/id/urn:aaid:sc:EU:f96fe528-0a47-457c-b29a-a7efb87221e0 · Manchester Haematology GP guide: https://mft.nhs.uk/app/uploads/2021/02/MFT-Haematology-GP-Pathway-Guide-v4-11.2.21.pdf · King’s Health Partners: https://www.kingshealthpartners.org/assets/000/002/294/KCH_-_king_s_health_partners_-_quick_guide_to_haematology_original.pdf · Medscape / Kevin Fernando- management of abnormal blood tests: https://1drv.ms/b/s!AiVFJ_Uoigq0mQPPwvFNZtsUSpIr?e=xYthDn · Oxford hospital referral pathway: https://nssg.oxford-haematology.org.uk/general-haematology/documents/general-haematology/raised-haematocrit.pdf · GP notebook: https://gpnotebook.com/en-GB/pages/general-information/abnormal-fbc-in-adults Intro / outro music: Track: Halfway Through — Broke In Summer [Audio Library Release] Music provided by Audio Library Plus Watch: https://youtu.be/aBGk6aJM3IU Free Download / Stream: https://alplus.io/halfway-through Transcript If you are listening to this podcast on YouTube, for a better experience, switch to the video version. The link is in the top right corner of the video and in the episode description. Hello and welcome, I’m Fernando, a GP in the UK. Today we are going to go through the interpretation of full blood counts, including follow up management, always focusing on what is relevant in Primary Care only. I will be covering several areas: 1. Review of haematological indices 2. Polycythaemia 3. Anaemia 4. Thrombocytosis 5. Thrombocytopenia 6. Neutrophilia 7. Neutropenia 8. Lymphocytosis 9. Lymphopenia 10. Eosinophilia 11. Monocytosis I have put time stamps throughout the video so that you can skip to the section that you are interested in. I have based this episode on a variety of sources, primarily Haematological guidance by Camden CCG, Manchester Foundation Trust and King’s Health Partners, although other sources like Medscape and GP notebook were also reviewed. I have put links to them in the episode description. They are worth having a look as they have flowcharts and other information that you may find useful. Make sure to stay for the entire episode because at the end, I will tell you how to access my summary of the recommendations, which I hope that you will find helpful. Right, there is a lot of information to cover, so let’s jump into it. I will now go through the blood indices on the full blood count and I will...

The video version of this podcast can be found here: https://youtu.be/0r2kJQNzHME?si=hwG9mG3jNVaXRQEq This video makes reference to guidelines produced by the "National Institute for Health and Care Excellence" in the UK, also referred to as "NICE". Please note that the content on this channel reflects my professional interpretation/summary of the guidance and that I am in no way affiliated with, employed by or funded/sponsored by NICE. My name is Fernando Florido and I am a General Practitioner in the United Kingdom. In this video I will go through new and updated guidelines published in January 2024 by the National Institute for Health and Care Excellence (NICE), focusing on those that are relevant to Primary Care only. I am not giving medical advice; this video is intended for health care professionals, it is only my summary and my interpretation of the guidelines and you must use your clinical judgement. There is a podcast version of this and other videos that you can access here: Primary Care guidelines podcast: · Redcircle: https://redcircle.com/shows/primary-care-guidelines · Spotify: https://open.spotify.com/show/5BmqS0Ol16oQ7Kr1WYzupK · Apple podcasts: https://podcasts.apple.com/gb/podcast/primary-care-guidelines/id1608821148 There is a YouTube version of this and other videos that you can access here: The Practical GP YouTube Channel: https://youtube.com/@practicalgp?si=ecJGF5QCuMLQ6hrk The Full NICE News bulletin for January 2024 can be found here: · https://www.nice.org.uk/guidance/published?from=2024-01-01&to=2024-01-31&ndt=Guidance&ndt=Quality+standard The links to the update guidance covered can be found here: Suspected sepsis: recognition, diagnosis and early management: · https://www.nice.org.uk/guidance/ng51 National early warning score information: · National Early Warning Score (NEWS) 2 | RCP London website: § https://www.rcplondon.ac.uk/projects/outputs/national-early-warning-score-news-2 · eLearning: § https://newslms.ocbmedia.com/login · The NEWS2 observation chart, score card and clinical responses can be downloaded from the main NEWS2 page at § https://news.ocbmedia.com/resources · COVID-19 rapid guideline: managing the long-term effects of COVID-19: · https://www.nice.org.uk/guidance/ng188 COVID-19 rapid guideline: managing COVID-19: · https://www.nice.org.uk/guidance/ng191 Skin cancer: · https://www.nice.org.uk/guidance/qs130 Intro / outro music: Track: Halfway Through — Broke In Summer [Audio Library Release] Music provided by Audio Library Plus Watch: https://youtu.be/aBGk6aJM3IU Free Download / Stream: https://alplus.io/halfway-through Transcript If you are listening to this podcast on YouTube, for a better experience, switch to the video version. The link is in the top right corner of the video and in the episode description. Hello and welcome, I am Fernando, a GP in the UK. Today, we are looking at the NICE updates published in January 2024, focusing on what is relevant in Primary Care only. And to be honest, there have not been any major changes, only minor tweaks in the guidelines on sepsis and COVID19. Today’s episode is not very long so let’s jump into it. The first clinical area is sepsis. We can’t really look at the whole sepsis guideline here so let’s just look at the update, which points out four aspects: · First, that temperature may not rise in cases of spinal cord injury. We know that some groups of people with sepsis may not develop a raised temperature. These include: o people who are older or very frail o young infants or children o people having cancer treatment o people severely ill with sepsis and after this update o people with a spinal cord injury · Second, we should suspect neutropenic sepsis also in immunosuppression which is not related to cancer. o That is, we should now suspect neutropenic sepsis and send them to hospital if they become unwell and: § Are having or have had systemic anticancer treatment within...

The video version of this episode can be found here: · https://youtu.be/2gDK6E85diU This episode makes reference to guidelines produced by the "National Institute for Health and Care Excellence" in the UK, also referred to as "NICE". Please note that the content on this channel reflects my professional interpretation/summary of the guidance and that I am in no way affiliated with, employed by or funded/sponsored by NICE. My name is Fernando Florido and I am a General Practitioner in the United Kingdom. In the first part of this episode, I go through the NICE guideline [NG28] on Type 2 diabetes in adults, always focusing on what is relevant in Primary Care only. In the second part I go through a thorough review of the guideline with a series of multiple-choice questions. Each question is paired with quotation, aiming to clarify key concepts and enhance understanding. This informative segment is created to support continuous learning in Primary Care. I am not giving medical advice; this video is intended for health care professionals; it is only my summary and my interpretation of the guidelines and you must use your clinical judgement. There is a podcast version of this and other videos that you can access here: Primary Care guidelines podcast: · Redcircle: https://redcircle.com/shows/primary-care-guidelines · Spotify: https://open.spotify.com/show/5BmqS0Ol16oQ7Kr1WYzupK · Apple podcasts: https://podcasts.apple.com/gb/podcast/primary-care-guidelines/id1608821148 There is a YouTube version of this and other videos that you can access here: The Practical GP YouTube Channel: https://youtube.com/@practicalgp?si=ecJGF5QCuMLQ6hrk The full NICE guideline can be found here: · https://www.nice.org.uk/guidance/ng28 Intro / outro music: Track: Halfway Through — Broke In Summer [Audio Library Release] Music provided by Audio Library Plus Watch: https://youtu.be/aBGk6aJM3IU Free Download / Stream: https://alplus.io/halfway-through Transcript If you are listening to this podcast on YouTube, for a better experience, switch to the video version. The link is in the top right corner of the video and in the episode description. Hello and welcome, I’m Fernando, a GP in the UK. Today we are going to do an up to date revision of the NICE guideline on type 2 diabetes. This episode is longer because it has two parts. In the first part, which lasts or about 20 minutes, I go through the NICE guideline itself, always focusing on what is relevant in Primary Care only. In the second part, I will present you with a series of multiple-choice questions so that you can test yourself. After each question, you are given the right answer, which is paired with a guiding quotation. This pairing is designed to clarify key concepts and enhance your continuous learning and retention. I have created time stamps throughout the video so that you can skip to the section that you wish whenever you want. Right, let’s jump into it. Firstly, I will just state that this episode does not cover the management of pregnant women with type 2 diabetes. We will offer structured education to patients at the time of diagnosis, with annual reinforcement and, if possible, this should be in the form of group education programmes. The dietary advice should be the same healthy eating advice as the general population, which includes: · high-fibre, low-glycaemic-index sources of carbohydrates · low-fat foods and · oily fish And we will discourage foods marketed specifically for people with diabetes. If the person is overweight, we should aim for an initial body weight loss target of 5% to 10%, remembering that even a small amount of weight loss may still be beneficial. The guideline on type 2 diabetes makes reference to the bariatric surgery guideline which says that we should refer people with type 2 diabetes for consideration of bariatric surgery if they have a BMI of 35 or more. If they have Asian or African-Caribbean family background, we...

The video version of this podcast can be found here: https://youtu.be/W0LL-1BwV3w?si=OT-GNCXaHoA7dcbs This podcast makes reference to guidelines produced by the "National Institute for Health and Care Excellence" in the UK, also referred to as "NICE". Please note that the content on this channel reflects my professional interpretation/summary of the guidance and that I am in no way affiliated with, employed by or funded/sponsored by NICE. My name is Fernando Florido and I am a General Practitioner in the United Kingdom. In this video I will go through a National Patient Safety Alert released on 3.1.2024 by the Department of Health and NHS England on the shortage of GLP1 receptor agonists, touching on sections of the NICE guideline on type 2 diabetes as well as relevant pharmaceutical information, always focusing on what is relevant in Primary Care only. I am not giving medical advice; this video is intended for health care professionals; it is only my summary and my interpretation of the guidelines and you must use your clinical judgement. There is a podcast version of this and other videos that you can access here: Primary Care guidelines podcast: · Redcircle: https://redcircle.com/shows/primary-care-guidelines · Spotify: https://open.spotify.com/show/5BmqS0Ol16oQ7Kr1WYzupK · Apple podcasts: https://podcasts.apple.com/gb/podcast/primary-care-guidelines/id1608821148 There is a YouTube version of this and other videos that you can access here: The Practical GP YouTube Channel: https://youtube.com/@practicalgp?si=ecJGF5QCuMLQ6hrk The PDF document related to the safety alert on GLP- RA shortage can be found here: · https://www.cas.mhra.gov.uk/ViewandAcknowledgment/ViewAttachment.aspx?Attachment_id=104161 The safety alert on GLP- RA shortage can be found here: · https://www.cas.mhra.gov.uk/ViewandAcknowledgment/ViewAlert.aspx?AlertID=103245 The Central Alerting System Homepage can be found here: · https://www.cas.mhra.gov.uk/Home.aspx Intro / outro music: Track: Halfway Through — Broke In Summer [Audio Library Release] Music provided by Audio Library Plus Watch: https://youtu.be/aBGk6aJM3IU Free Download / Stream: https://alplus.io/halfway-through Transcript If you are listening to this podcast on YouTube, for a better experience, switch to the video version. The link is in the top right corner of the video and in the episode description. Hello and welcome, I am Fernando, a GP in the UK. In this episode I will go through a National Patient Safety Alert released on 3.1.2023 by the Department of Health and NHS England on the shortage of GLP1 receptor agonists, touching on sections of the NICE guideline on type 2 diabetes as well as relevant pharmaceutical information, always focusing on what is relevant in Primary Care only. If you want to access the safety alert website or the associated PDF document, the link is in the episode description. Right, let’s jump into it. You are probably aware that the supply of GLP-1 receptor agonists continues to be limited, with supplies not expected to return to normal until at least the end of 2024. The supply issues have been caused by an increase in demand for these products for licensed and off-label indications. The situation at the moment is that exenatide as Byetta® will be discontinued in March 2024. In addition, liraglutide as Victoza® continues to be out of stock and further stock is not expected until end of 2024. The supply of other agents such as injectable semaglutide as Ozempic® and Dulaglutide as Trulicity® may be unreliable and the shortages may cause significant issues. So, what is the solution? Well, oral semaglutide has come to the rescue. Semaglutide as Rybelsus® tablets are now available in sufficient quantities to support initiation of GLP-1 RA for type 2 diabetes in line with NICE guidance. So let’s remind ourselves of what NICE recommends for type 2 diabetes. NICE says that if triple therapy with metformin and 2 other oral drugs is not...

This podcast makes reference to guidelines produced by the "National Institute for Health and Care Excellence" in the UK, also referred to as "NICE". Please note that the content on this channel reflects my professional interpretation/summary of the guidance and that I am in no way affiliated with, employed by or funded/sponsored by NICE. My name is Fernando Florido and I am a General Practitioner in the United Kingdom. In this video I will go through new and updated guidelines published in December 2023 by the National Institute for Health and Care Excellence (NICE), focusing on those that are relevant to Primary Care only. I am not giving medical advice; this video is intended for health care professionals, it is only my summary and my interpretation of the guidelines and you must use your clinical judgement. There is a podcast version of this and other videos that you can access here: Primary Care guidelines podcast: · Redcircle: https://redcircle.com/shows/primary-care-guidelines · Spotify: https://open.spotify.com/show/5BmqS0Ol16oQ7Kr1WYzupK · Apple podcasts: https://podcasts.apple.com/gb/podcast/primary-care-guidelines/id1608821148 There is a YouTube version of this and other videos that you can access here: The Practical GP YouTube Channel: https://youtube.com/@practicalgp?si=ecJGF5QCuMLQ6hrk The Full NICE News bulletin for December 2023 can be found here: · https://www.nice.org.uk/guidance/published?from=2023-12-01&to=2023-12-30&ndt=Guidance&ndt=Quality+standard The links to the update guidance covered can be found here: Bipolar disorder: assessment and management: · https://www.nice.org.uk/guidance/cg185 Empagliflozin for treating chronic kidney disease: · https://www.nice.org.uk/guidance/ta942 Cardiovascular disease: risk assessment and reduction, including lipid modification: · https://www.nice.org.uk/guidance/ng238 Intro / outro music: Track: Halfway Through — Broke In Summer [Audio Library Release] Music provided by Audio Library Plus Watch: https://youtu.be/aBGk6aJM3IU Free Download / Stream: https://alplus.io/halfway-through Transcript Hello and welcome, I am Fernando, a GP in the UK. Today, we are looking at the NICE updates published in December 2023, focusing on what is relevant in Primary Care only. We will be covering: valproate toxicity, empagliflozin for CKD, and cardiovascular risk reduction. The episode is fairly short so let’s jump into it. The first clinical area refers to the use of valproate in the bipolar disorder guideline, in line with new MHRA guidance published in November 2023. And perhaps we should remember that the previous MHRA advice stated that valproate must not be used in women and girls of childbearing potential unless other options are unsuitable and a pregnancy prevention programme is in place. But the new safety advice is much stricter and states that valproate must not be started in people (either male or female) younger than 55 years, unless 2 specialists independently consider that there is no other treatment, or that the reproductive risks do not apply. So, let’s have a look at this in a bit more detail. We know that valproate must not be used in pregnancy as well as in any female of child bearing age unless there is a Pregnancy Prevention Programme in place, which involves an annual review and the requirement for highly effective methods of contraception (such as a hormonal intrauterine device). This is because of the risks of malformations and developmental problems. Valproate is a known teratogenic drug, resulting in both physical birth defects and neurodevelopmental harm including lower intellectual abilities, poor language skills and memory problems. Although the risk of structural malformations is greatest in the first trimester, the risk of neurodevelopmental harm is thought to be present throughout, and therefore valproate is never safe in pregnancy. But the new guidance also includes males. Why is this? Well, although less...

This episode makes reference to guidelines produced by the “National Institute for Health and Care Excellence” in the UK, also referred to as “NICE”. Please note that the content on this channel reflects my professional interpretation/summary of the guidance and that I am in no way affiliated with, employed by or funded/sponsored by NICE. My name is Fernando Florido and I am a General Practitioner in the United Kingdom. In this episode I will go through the NICE guidance on the management of lower urinary tract symptoms in men. I will summarise the guidance from a Primary Care perspective only. I am not giving medical advice; this video is intended for health care professionals; it is only my interpretation of the guidelines and you must use your clinical judgement. There is a podcast version of this and other videos that you can access here: Primary Care guidelines podcast: · Redcircle: https://redcircle.com/shows/primary-care-guidelines · Spotify: https://open.spotify.com/show/5BmqS0Ol16oQ7Kr1WYzupK · Apple podcasts: https://podcasts.apple.com/gb/podcast/primary-care-guidelines/id1608821148 There is a YouTube version of this and other videos that you can access here: The Practical GP YouTube Channel: https://youtube.com/@practicalgp?si=ecJGF5QCuMLQ6hrk The full clinical guideline CG97 on lower urinary tract symptoms in men: management can be found here: · https://www.nice.org.uk/guidance/cg97 The International Prostatism Symptom Score calculator can be found here: · https://www.uptodate.com/contents/calculator-international-prostatism-symptom-score-ipss Intro / outro music: Track: Halfway Through — Broke In Summer [Audio Library Release] Music provided by Audio Library Plus Watch: https://youtu.be/aBGk6aJM3IU Free Download / Stream: https://alplus.io/halfway-through Transcript Hello and welcome, I am Fernando, a GP in the UK. Today, we will go through the NICE guidance on the management of lower urinary tract symptoms in men, which I have summarised from a Primary Care perspective. So, let’s jump into it. And to appreciate fully the importance of this subject, let’s have a look at this anonymous poem: “As man draws near the common goal Can anything be sadder Than he who, master of his soul Is servant to his bladder‟ And, of course, we know that the prevalence and severity of male lower urinary tract symptoms, also known as LUTS, increase with age and although transurethral resection of the prostate is often effective, about a quarter of men have poor post-surgical outcomes and some failures can be attributed to an incorrect initial diagnosis. So, let’s start by talking about the conditions that can cause LUTS in men. And in order to get the correct diagnosis, we should remember the ancient Chinese proverb that says that the “bladder is the mirror of the soul‟ and therefore LUTS can result from not only bladder dysfunction or prostatic pathology but also from a number of other causes, e.g., metabolic, hormonal, cardiac, respiratory, etc. And therefore, effective therapy depends on the accurate diagnosis of the underlying problem. Although, the most common cause is benign prostate enlargement (BPE), which obstructs the bladder outlet, the term LUTS is an umbrella term introduced to dispel the perception that male urinary symptoms are simply caused by prostate problems. Because other conditions, for example, detrusor muscle problems, prostatitis, UTIs, prostate cancer and neurological disease, can also cause LUTS. We also need to be aware of the 3 stages of the bladder cycle, which are: · Storage - during which filling of the bladder occurs · Voiding - during which the bladder actively expels its contents and · Post micturition - immediately after voiding when the bladder returns to storage function. And as a result, LUTS comprise three different types of symptoms: · First, storage symptoms normally causing daytime urinary frequency, nocturia, urgency and urinary...

This episode makes reference to guidelines produced by the "National Institute for Health and Care Excellence" in the UK, also referred to as "NICE". Please note that the content on this channel reflects my professional interpretation/summary of the guidance and that I am in no way affiliated with, employed by or funded/sponsored by NICE. My name is Fernando Florido and I am a General Practitioner in the United Kingdom. In this episode I will go through a number of NICE products on insomnia, including guidance on the medical technology sleepio, and the prescribing of z-drugs, daridodexant and melatonin. I will summarise the guidance from a Primary Care perspective only. I am not giving medical advice; this video is intended for health care professionals; it is only my interpretation of the guidelines and you must use your clinical judgement. There is a podcast version of this and other videos that you can access here: Primary Care guidelines podcast: · Redcircle: https://redcircle.com/shows/primary-care-guidelines · Spotify: https://open.spotify.com/show/5BmqS0Ol16oQ7Kr1WYzupK · Apple podcasts: https://podcasts.apple.com/gb/podcast/primary-care-guidelines/id1608821148 There is a YouTube version of this and other videos that you can access here: The Practical GP YouTube Channel: https://youtube.com/@practicalgp?si=ecJGF5QCuMLQ6hrk The Medical technologies guidance [MTG70] on “Sleepio to treat insomnia and insomnia symptoms” can be found here: · https://www.nice.org.uk/guidance/mtg70 The Technology appraisal guidance [TA77] “Guidance on the use of zaleplon, zolpidem and zopiclone for the short-term management of insomnia” can be found here: · https://www.nice.org.uk/guidance/ta77 The Technology appraisal guidance [TA922] “Daridorexant for treating long-term insomnia” can be found here: · https://www.nice.org.uk/guidance/ta922 The Evidence summary [ES38] “Melatonin for treating sleep disorders in adults who are blind” can be found here: · https://www.nice.org.uk/advice/es38/chapter/Product-overview Thumbnail photo: from Freepik: https://www.freepik.com/ · Image by Freepik · Image by a href="https://www.freepik.com/free-photo/flat-lay-woman-laying-bed_28694061.htm#query=insomnia&position=21&from_view=search&track=sph&uuid=65539da6-4c29-453b-9d22-c39df5176601"Freepik/a Intro / outro music: Track: Halfway Through — Broke In Summer [Audio Library Release] Music provided by Audio Library Plus Watch: https://youtu.be/aBGk6aJM3IU Free Download / Stream: https://alplus.io/halfway-through Transcript Hello and welcome, I am Fernando, a GP in the UK. Today, we will go through a number of NICE publications on insomnia, including guidance on digital cognitive behavioural therapy for insomnia (CBT-I), and the prescribing of hypnotics, daridodexant and melatonin, all of them from a Primary Care perspective. By the way, make sure that you stay for the entire episode because, at the end, I will go through some audit ideas backed by NICE which you could use as a Quality Improvement Project in your practice. So, let’s jump into it. Let’s talk a little about the condition first. Insomnia is a disturbance of sleep characterised by difficulty in initiating and/or maintaining sleep. However, insomnia is highly subjective and although most healthy adults typically sleep between 7 and 9 hours per night, patterns vary between people, and in any given person there are also variations from night to night. Estimates of the prevalence of insomnia vary and while up to 48% of people have reported sleeping issues, only 6% met the criteria for a diagnosis of insomnia. So, in general practice, differentiating between simple sleeping problems and significant insomnia is important before considering treatment. The prevalence of insomnia is higher in women and increases with age and, although the majority do not seek medical advice, the treatment depends on the duration and nature of the symptoms. Appropriate management of...

This podcast makes reference to guidelines produced by the "National Institute for Health and Care Excellence" in the UK, also referred to as "NICE". Please note that the content on this channel reflects my professional interpretation/summary of the guidance and that I am in no way affiliated with, employed by or funded/sponsored by NICE. My name is Fernando Florido and I am a General Practitioner in the United Kingdom. In this video I will go through new and updated guidelines published in November 2023 by the National Institute for Health and Care Excellence (NICE), focusing on those that are relevant to Primary Care only. I am not giving medical advice; this video is intended for health care professionals, it is only my interpretation of the guidelines and you must use your clinical judgement. There is a podcast version of this and other videos that you can access here: Primary Care guidelines podcast: · Redcircle: https://redcircle.com/shows/primary-care-guidelines · Spotify: https://open.spotify.com/show/5BmqS0Ol16oQ7Kr1WYzupK · Apple podcasts: https://podcasts.apple.com/gb/podcast/primary-care-guidelines/id1608821148 There is a YouTube version of this and other videos that you can access here: The Practical GP YouTube Channel: https://youtube.com/@practicalgp?si=ecJGF5QCuMLQ6hrk The Clinic BP targets flowchart can be downloaded here: · https://1drv.ms/b/s!AiVFJ_Uoigq0mFp2iUfq8rimJSmo?e=BnJaCD The Clinic BP targets tables can be downloaded here: · https://1drv.ms/b/s!AiVFJ_Uoigq0mFtrsXeUGOB58DKE?e=J7filE The Full NICE News bulletin for November 2023 can be found here: · https://www.nice.org.uk/guidance/published?from=2023-11-01&to=2023-11-30&ndt=Guidance&ndt=Quality+standard The links to the update guidance covered can be found here: Hypertension in adults: diagnosis and management: · https://www.nice.org.uk/guidance/ng136 Transient loss of consciousness ('blackouts') in over 16s: · https://www.nice.org.uk/guidance/cg109 Suspected acute respiratory infection in over 16s: assessment at first presentation and initial management: · https://www.nice.org.uk/guidance/ng237 Empagliflozin for treating chronic heart failure with preserved or mildly reduced ejection fraction: · https://www.nice.org.uk/guidance/ta929 Thumbnails photos: From Freepik: Download Free Videos, Vectors, Photos, and PSD - https://www.freepik.com/ o Image by Freepik: Image by a href="https://www.freepik.com/free-photo/doctor-checking-blood-pressure-male-patient_14001674.htm#query=blood%20pressure%20lying%20down&position=38&from_view=search&track=ais&uuid=cdea12ca-0d0a-43b4-a4a1-2b7142ffb839"Freepik/a o Image by master1305 on Freepik: o a href="https://www.freepik.com/free-photo/visiting-nurse-health-visitor-taking-care-senior-man_11163175.htm#query=low%20blood%20pressure&position=40&from_view=keyword&track=ais&uuid=e445d882-3755-471d-a9f6-61aaa7f1bbd9">Image by master1305/a on Freepik o Image by kjpargeter on Freepik: o a href="https://www.freepik.com/free-photo/3d-render-medical-background-with-male-figure-lungs-covid-19-virus-cells_22404919.htm#page=2&query=chest%20infection&position=24&from_view=search&track=ais&uuid=9048f228-9941-4745-8afd-4d60e59daa45">Image by kjpargeter/a on Freepik Intro / outro music: Track: Halfway Through — Broke In Summer [Audio Library Release] Music provided by Audio Library Plus Watch: https://youtu.be/aBGk6aJM3IU Free Download / Stream: https://alplus.io/halfway-through Transcript Hello and welcome, I am Fernando, a GP in the UK. Today, we are looking at the NICE updates published in November 2023, focusing on what is relevant in Primary Care only. We will be covering: postural hypotension, empagliflozin for HFpEF, and acute respiratory infections. Make sure to stay for the entire episode because, at the end, I will go through the new tables published by NICE summarising blood pressure targets in the hypertension guideline as well as in the guidelines on...

This episode makes reference to guidelines produced by the "National Institute for Health and Care Excellence" in the UK, also referred to as "NICE". Please note that the content on this channel reflects my professional interpretation/summary of the guidance and that I am in no way affiliated with, employed by or funded/sponsored by NICE. My name is Fernando Florido and I am a General Practitioner in the United Kingdom. In this episode I will go through the NICE guideline on “Menopause: diagnosis and management” or NICE guideline NG23. I will summarise the guidance from a Primary Care perspective only. I am not giving medical advice; this video is intended for health care professionals; it is only my interpretation of the guidelines and you must use your clinical judgement. There is a YouTube version of this and other videos that you can access here: The Practical GP YouTube Channel: https://youtube.com/@practicalgp?si=ecJGF5QCuMLQ6hrk The NICE guideline NG23 “Menopause: diagnosis and management” can be found here: https://www.nice.org.uk/guidance/NG23 The guidance from the Faculty of Sexual & Reproductive Healthcare on contraception for women aged over 40 years can be found here: http://www.fsrh.org/pdfs/ContraceptionOver40July10.pdf The MHRA summary of HRT risks and benefits during current use and current use plus post-treatment from age of menopause up to age 69 years, per 1000 women with 5 years or 10 years use of HRT can be found here: https://assets.publishing.service.gov.uk/media/5d680409e5274a1711fbe65a/Table1.pdf The summary flowchart with examples of preparations can be found here: https://1drv.ms/b/s!AiVFJ_Uoigq0mFjbJIiJs842urJB?e=FcfiJl Thumbnail photo: from Freepik: https://www.freepik.com/ Image by LipikStockMedia on Freepik: ahref="https://www.freepik.com/free-photo/beautiful-woman-50-years-old-enjoys-yoga-she-is-meditating-by-cupping-her-palms-front-her-with-her-eyes-closed-she-dreams-personal-one-close-up-shot_23935463.htm#page=2&query=menopause&position=9&from_view=search&track=sph&uuid=9a84a386-a034-42ca-ac20-add7c2fb2d27"Image by LipikStockMedia/a on Freepik Intro / outro music: Track: Halfway Through — Broke In Summer [Audio Library Release] Music provided by Audio Library Plus Watch: https://youtu.be/aBGk6aJM3IU Free Download / Stream: https://alplus.io/halfway-through Transcript Hello and welcome, I am Fernando, a GP in the UK. Mrs Brown sees you because wants to discuss HRT in detail, including the pros and cons of the various preparations available. Do you say?: “of course, ask me anything you want” or do you go? ….. If you are in the second group then you know exactly how I feel. So, today, we will go through the NICE guideline on the diagnosis and management of the menopause from a Primary Care perspective. Make sure to stay for the entire episode because, at the end, I will also go through a one-page summary flowchart giving cost effective examples of various preparations available which you will also be able to download So, let’s jump into it. And let’s start by saying that possible symptoms of the menopause include: · a change in their menstrual cycle · vasomotor symptoms (e.g., hot flushes and sweats) · musculoskeletal symptoms (e.g., joint and muscle pain) · effects on mood (e.g., low mood) · urogenital symptoms (e.g., vaginal dryness) and · sexual difficulties (e.g., low sexual desire). When these symptoms are present, most women will ask for a blood test to check if they are menopausal. Is this really necessary? Well, most of the time, it isn’t. Because NICE says that we can make the following diagnoses without checking FSH: perimenopause in women over 45 with vasomotor symptoms and irregular periods and menopause in women over 45: · If they are not using contraception and have had no periods for at least 12 months or · based on symptoms alone if the woman does not have a uterus Of course, diagnosis can be more difficult if...

This episode makes reference to guidelines produced by the "National Institute for Health and Care Excellence" in the UK, also referred to as "NICE". Please note that the content on this channel reflects my professional interpretation/summary of the guidance and that I am in no way affiliated with, employed by or funded/sponsored by NICE. My name is Fernando Florido and I am a General Practitioner in the United Kingdom. In this episode I will go through the NICE guideline on “Headaches in over 12s: diagnosis and management”, or NICE guideline CG150. I will summarise the guidance from a Primary Care perspective only. I am not giving medical advice; this video is intended for health care professionals; it is only my interpretation of the guidelines and you must use your clinical judgement. There is a YouTube version of this and other videos that you can access here: The Practical GP YouTube Channel: https://youtube.com/@practicalgp?si=ecJGF5QCuMLQ6hrk The NICE guideline CG150 “Headaches in over 12s: diagnosis and management” can be found here: · https://www.nice.org.uk/guidance/cg150/chapter/Recommendations Thumbnail photo: from Freepik: https://www.freepik.com/ · Image by Drazen Zigic on Freepik · a href="https://www.freepik.com/free-photo/low-angle-view-distraught-man-holding-his-head-pain-while-sitting-living-room_26343742.htm#query=headache&position=2&from_view=search&track=sph"Image by Drazen Zigic/a on Freepik Intro / outro music: Track: Halfway Through — Broke In Summer [Audio Library Release] Music provided by Audio Library Plus Watch: https://youtu.be/aBGk6aJM3IU Free Download / Stream: https://alplus.io/halfway-through  Transcript Hello and welcome, I am Fernando, a GP in the UK. Today, we will go through the NICE guideline on headaches and I will summarise the guidance from a Primary Care perspective only. So, let’s jump into it. We will start by looking at the diagnostic clinical features that could help differentiate between tension‑type headache, migraine and cluster headache. · First, we have the Pain location which: o In Tension headache: is usually Bilateral o In Migraine: can be Unilateral or bilateral o And in Cluster headache: is Unilateral (usually around the eye, above the eye and along the side of the head/face) · Then we look at the Pain quality which: o In Tension headache: is usually Pressing or tightening and non‑pulsating o In Migraine: is generally Pulsating (although it can be described as throbbing or banging in those aged 12 to 17 years) o And in Cluster headache: it is Variable (sharp, boring, burning, throbbing or tightening) · The Pain intensity is: o Mild or moderate in Tension headache: o Moderate or severe in Migraine: o And Severe or very severe in Cluster headache: · In terms of the Effect on activities we find that: o Tension headache: Is Not aggravated by routine activities o Migraine: is Aggravated by, or causes avoidance of, routine activities o And Cluster headache: causes Restlessness or agitation · Looking at Other possible symptoms we find that: o Tension headache: doesn’t usually have any o Migraine: usually produces Sensitivity to light and/or sound or nausea and/or vomiting. There can also be aura symptoms, which we will cover in more detail later. o and Cluster headache: will normally present On the same side as the headache: · and finally, in terms of Duration of the headache: o Tension headaches can be from 30 minutes to continuous: o Migraine: can be 4 to 72 hours in adults but 1 to 72 h in those aged 12 to 17 o And Cluster headache: usually lasts 15 to 180 minutes Episodic tension-type headaches or episodic migraines occur on fewer than 15 days per month. Chronic tension-type headaches or chronic migraines occur on 15 or more days per month for more than 3 months. Chronic migraine and chronic tension‑type headache commonly overlap so, if there are features of migraine, we will diagnose chronic migraine. On the other hand,...

This episode makes reference to guidelines produced by the "National Institute for Health and Care Excellence" in the UK, also referred to as "NICE". Please note that the content on this channel reflects my professional interpretation/summary of the guidance and that I am in no way affiliated with, employed by or funded/sponsored by NICE. My name is Fernando Florido and I am a General Practitioner in the United Kingdom. In this episode I will go through the NICE guideline on “Heavy menstrual bleeding: assessment and management”, or NICE guideline [NG88. I will summarise the guidance from a Primary Care perspective only. I am not giving medical advice; this video is intended for health care professionals; it is only my interpretation of the guidelines and you must use your clinical judgement. There is a YouTube version of this and other videos that you can access here: The Practical GP YouTube Channel: https://youtube.com/@practicalgp?si=ecJGF5QCuMLQ6hrk The NICE guideline NG88 “Heavy menstrual bleeding: assessment and management” can be found here: · https://www.nice.org.uk/guidance/ng88/chapter/Recommendations The Menorrhagia mind map or flow chart can be downloaded here: · https://1drv.ms/i/s!AiVFJ_Uoigq0mFegr4-vdKdhitAI?e=BJRIDK Thumbnail photo: from Freepik: https://www.freepik.com/ · Image by benzoix on Freepik · a href="https://www.freepik.com/free-photo/young-woman-with-pain-stomach-holding-hands-belly-feeling-terrible-ache-menstrual-cramps-stand_34232826.htm#query=heavy%20periods&position=17&from_view=search&track=ais"Image by benzoix/a on Freepik Intro / outro music: Track: Halfway Through — Broke In Summer [Audio Library Release] Music provided by Audio Library Plus Watch: https://youtu.be/aBGk6aJM3IU Free Download / Stream: https://alplus.io/halfway-through Transcript Hello and welcome, I am Fernando, a GP in the UK. Today, we will go through the NICE guideline on menorrhagia or, to be precise, “Heavy menstrual bleeding: assessment and management” and I will summarise the guidance from a Primary Care perspective only. So, let’s jump into it. We will obviously start with the history including the nature and impact of the bleeding and we will particularly pay attention to what NICE refers to as “related symptoms”. These are symptoms such as: · Persistent intermenstrual bleeding · Pelvic pain and/or · Pressure symptoms, because they might suggest a uterine abnormality. What may come as a surprise is that NICE says that if none of these symptoms are present, that is, no IMB, no pain and no pressure symptoms, we will consider pharmacological treatment without necessarily carrying out a physical examination. But the converse is true, a physical examination is recommended if such symptoms exist or if we are considering a levonorgestrel-releasing intrauterine system [LNG IUS], that is, a Mirena coil or similar. In terms of blood tests: · we will perform a FBC for all patients and · we will consider testing for coagulation disorders if they have had heavy periods since they started and there is a personal or family history suggestive of it · However, NICE says that there is no need for routine ferritin, hormone or thyroid testing We will then consider investigations for the cause of the HMB but We will also consider starting pharmacological treatment without investigating the cause if we feel that there is a low risk of uterine abnormality. If we do investigate further, we will consider the need for: · Hysteroscopy · A pelvic USS or · A transvaginal USS And we will choose each investigation depending on whether we suspect: · submucosal fibroids, polyps or endometrial pathology (in which case a hysteroscopy would be needed) · larger fibroids (in which case a pelvic USS would be needed) or · adenomyosis (when a transvaginal USS would be recommended) And we will use our clinical judgement to decide which one of those we should consider as most likely. For example: · We will suspect...