Épisodes

  • Podcast - NICE News - May 2024

    Podcast - NICE News - May 2024
    Jun 4 2024
    The video version of this podcast can be found here:https://youtu.be/KjALe_M-tIwThis 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 May 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/id1608821148There is a YouTube version of this and other videos that you can access here: The Practical GP YouTube Channel: https://youtube.com/@practicalgp?si=ecJGF5QCuMLQ6hrkThe YouTube video on the management of headaches can be found here:· https://youtu.be/6AZttMzfFr0?si=yxPcoC4legE8zS_pThe Full NICE News bulletin for May 2024 can be found here:· https://www.nice.org.uk/guidance/published?from=2024-05-01&to=2024-05-31&ndt=Guidance&ndt=Quality+standardThe links to the guidance covered can be found here: Atogepant for preventing migraine - Technology appraisal guidance [TA973] can be found here:· https://www.nice.org.uk/guidance/ta973Headaches in over 12s: diagnosis and management - Clinical guideline [CG150] can be found here:· https://www.nice.org.uk/guidance/cg150The educational poster on the diagnosis of diagnosis of tension-type headache, migraine and cluster headache can be found here:· https://www.nice.org.uk/guidance/cg150/resources/diagnosis-poster-pdf-188219341 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 TranscriptIf 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 May 2024, focusing on what is relevant in Primary Care only. And again, in May we have had very little new guidance relevant to primary care, in fact, there was only one guideline containing relevant information for us, the published technology appraisal on atogepant for migraine prophylaxis. You may remember that we covered this to some degree last month, when we reviewed the final draft NICE guidance on the subject. To make up for the shortage of Primary Care updates, we will also go through the clinical signs and symptoms that differentiate between tension-type headache, migraine and cluster headache. We will do so by reviewing the NICE guideline on headaches. If you are interested in the full headache guideline, covering headaches other than migraine, please see the corresponding video on this channel. The link is in the episode description. Right, we have a migraine heavy episode, so let’s jump into it. And let’s start with an overview. Although we are covering atogepant, the guidance on Rimegepant is very similar. Both Rimegepant and atogepant, are a new class of drugs, also known as gepants, that have been developed specifically for the treatment of migraines. They are a calcitonin gene-related peptide (or CGRP) receptor antagonist which works by blocking this CGRP receptor. And although the mechanism of action is not fully understood, we know that CGRP is a protein found in the sensory nerves of the head and neck and causes blood vessels to dilate, which can lead to inflammation and migraine pain. Unlike triptans, gepants do not cause vasoconstriction so they do not have the same cardiovascular contraindications and cautions as triptans.Gepants can be used as an acute treatment of migraine and also as prophylaxis, but only if there have been at least 4 migraine days per month and where at least 3 previous preventive treatments have failed. Rimegepant is only recommended as prophylaxis of episodic migraines, whereas NICE has recommended atogepant as prophylaxis for both chronic and episodic migraines.What’s the difference between episodic and chronic migraine?The definition of episodic migraine is when there are fewer ...
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    9 min
  • Podcast - 2024 Heart Failure update: NICE guideline

    Podcast - 2024 Heart Failure update: NICE guideline
    May 20 2024
    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 TranscriptIf 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‑proBNPHigh 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 failure with preserved ejection fraction is usually associated with impaired left ventricular relaxation, rather than left ventricular contraction, so it has normal left ventricular ejection fraction and evidence of diastolic dysfunction, whereas the opposite is true for heart failure with reduced ejection fraction, when the ejection fraction is below 40%. · the NT‑proBNP level can be reduced in obesity, African or African–Caribbean family background, or drugs such as diuretics, ACE inhibitors, ARBs, beta‑blockers, and mineralocorticoid receptor antagonists or MRAs · conversely, the NT‑proBNP level can be high due to other reasons such as, for example, age over 70 years, left ventricular hypertrophy, ischaemia, tachycardia, right ventricular overload, hypoxaemia, like in PE and COPD, eGFR less than 60, sepsis...
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    14 min
  • Podcast - NICE on Hypertension: Can you pass the test?

    Podcast - NICE on Hypertension: Can you pass the test?
    May 14 2024
    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/ng136The 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 TranscriptIf 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-blockerThe correct answer is: ACE inhibitor or ARBNICE 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 originWhat is recommended regarding lifestyle advice for people with suspected or diagnosed hypertension? Offer magnesium, and potassium supplements. Discourage excessive consumption of coffee and other caffeine-rich products. Avoid physical activity. Offer calcium supplements.The correct answer is: Discourage excessive consumption of coffee and other caffeine-rich products.NICE quote:Discourage excessive consumption of coffee and other caffeine-rich products. Emma, a 54-year-old woman with hypertension, is taking an ACE inhibitor as step 1 treatment. Despite this, her blood pressure remains uncontrolled. What should be offered to her as step 2 treatment? Alpha-blocker Calcium-channel blocker ARB Beta-blockerThe correct answer is: Calcium-channel blockerNICE quote:If hypertension is not controlled in adults taking step 1 treatment of an ACE inhibitor or ARB, offer the choice of 1 of the following drugs in addition to step 1 treatment:a Calcium-channel blocker ora thiazide-like diuretic. James, a 40-year-old man, has severe hypertension of 188/123 with no symptoms indicating ...
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    1 h et 5 min
  • Podcast - NICE News - April 2024

    Podcast - NICE News - April 2024
    May 7 2024
    The video version of this podcast can be found here: https://youtu.be/dVpfeUxt8K8This 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+standardThe 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/ng73Final draft guidance on Atogepant for preventing migraine [ID5090] | can be found here:· https://www.nice.org.uk/guidance/indevelopment/gid-ta10992/documentsIntro / 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 TranscriptIf 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 dysuriaWe 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 high level may be consistent with endometriosis but that· endometriosis may be present despite normal serum CA125 levelsEqually, pelvic MRI is not recommended as a primary investigation for endometriosis. However, this can be considered in secondary care to assess the extent of deep endometriosis involving the bowel, bladder or ureter.But, and this is an important but, we must not exclude endometriosis just because the examination, ultrasound or MRI are normal. If there is a high clinical suspicion, we should refer for further assessment.So, the question is, should we be initiating investigations in Primary Care if we know that we may end up referring to gynaecology anyway?My view is that if there is a high clinical suspicion of endometriosis, then we are probably better off referring the patient straightaway, as this is likely to lead to an earlier diagnosis and management. However, if we...
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    7 min
  • Podcast - Hypertensive urgency or emergency? Spot the difference...

    Podcast - Hypertensive urgency or emergency? Spot the difference...
    Apr 28 2024
    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/ng136The 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=J7filEWorcestershire 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=1The Worcestershire Acute Hospitals NHS Trust Hypertensive crisis flowchart can be downloaded here: · https://1drv.ms/b/s!AiVFJ_Uoigq0mRX6no6c5m3ddfEC?e=aPVQ67NICBH 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=1NEJM article: Acute severe hypertension:· https://www.nejm.org/doi/full/10.1056/NEJMcp1901117Approach 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 TranscriptIf 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. · Severe hypertension is defined as SBP ≥180mmHg and/or DBP ≥120mmHg · Hypertensive emergency is defined as severe hypertension associated with evidence of target organ damage. · Hypertensive urgency is defined as severe hypertension without evidence of ongoing target organ damage. Studies have shown that Hypertensive urgency is two to three times more common than hypertensive emergencies.We know from the hypertension NICE guideline that for people with a BP of 180/120 or higher we should investigate for target organ damage, that is, we have to differentiate between hypertensive urgency and emergency. Starting with the history, we should look at possible causes, and non-compliance with antihypertensive drug treatment is the most common precipitating factor. Other possible factors include excess alcohol, anxiety or panic, drugs, either prescribed, ...
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    17 min
  • Podcast - 2024 Hypertension update: NICE guideline

    Podcast - 2024 Hypertension update: NICE guideline
    Apr 21 2024
    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/ng136Chronic kidney disease: assessment and management - NICE guideline [NG203]:· https://www.nice.org.uk/guidance/ng203The 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 TranscriptIf 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 necessaryAlso, 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 higher reading. If BP measured in the clinic is 140/90 mmHg or higher:· We will take a second measurement.· If it is substantially different, we will take a third measurement and we will record the lowest of them as the clinic BP. If clinic BP is between 140/90 mmHg and 180/120 mmHg, we will confirm hypertension by doing ambulatory BP monitoring (ABPM) or, if necessary, home BP monitoring (HBPM). While waiting, we will:· Estimate the cardiovascular risk using the clinic BP and we will· Carry out investigations for target organ damage by doing:o A urine test for a haematuria dipstick and an albumin-creatinine ratio or ACRo A blood test for HbA1C, renal function, total cholesterol and HDL cholesterolo A 12‑lead ECG o And examination of the fundi for the presence of ...
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    14 min
  • Podcast - NICE News - March 2024

    Podcast - NICE News - March 2024
    Apr 1 2024
    The video version of this podcast can be found here: https://youtu.be/41MH-Z-tcf8This 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+standardThe 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/ng241Meningitis (bacterial) and meningococcal disease: recognition, diagnosis and management- NICE guideline [NG240] can be found here:· https://www.nice.org.uk/guidance/ng240Vitamin B12 deficiency in over 16s: diagnosis and management- NICE guideline [NG239] can be found here:· https://www.nice.org.uk/guidance/ng239My summary of meningitis and meningococcal disease symptoms can be found here:· https://1drv.ms/b/s!AiVFJ_Uoigq0mRE17SGM9XfnH-0n?e=lx7zVg2-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 TranscriptIf 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 they have:· A first or second degree relative with a diagnosis of ovarian cancer· A diagnosis of ovarian cancer themselves· They have already been identified to be at high risk and if· they are from an at‑risk population, that is, those with at least 1 grandparent from the following populations:o Ashkenazi Jewisho Sephardi Jewish ando GreenlanderAs we know, the combined oral contraceptive reduces the risk of ovarian cancer. However, we will only give it to reduce the risk of ovarian cancer if the reduction in the ovarian cancer risk outweighs the increased risk of breast cancer Equally, we can offer HRT until the average age of menopause (usually around 51 years) for people who:· have not had breast cancer and· have had bilateral salpingo-oophorectomy For those who have had breast cancer, HRT should be discussed with ...
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    10 min
  • Podcast - Non-visible haematuria: and now, what?!

    Podcast - Non-visible haematuria: and now, what?!
    Mar 23 2024
    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-cancersChronic kidney disease: assessment and management - NICE guideline [NG203]:· https://www.nice.org.uk/guidance/ng203Joint 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.pdfAssessment 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.pdfNorth Central London Haematuria clinical pathway PDF:· https://gps.northcentrallondon.icb.nhs.uk/pathways/haematuriaInvestigating painless haematuria BMJ article - BMJ 2008;337:a260:· https://www.bmj.com/content/337/bmj.a260South 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 TranscriptIf 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 link to download my summary, which I hope that you will find useful Right, so let’s jump into it.And the reason why this subject generates so many questions is because, when it comes to non-visible haematuria, we are often unsure if and when patients need to be referred and whether they should be referred, to urology, nephrology, or both.Metanalysis have demonstrated that there is insufficient trial evidence from high quality studies to answer questions relevant to clinical care and therefore clinical pathways are based on consensus agreement and expert opinions. These have changed over the years and, although the oint Consensus Statement of the Renal Association and British Association of Urological Surgeons has been superseded since they were published in 2008, most of their recommendations remain valid and have been incorporated into Primary Care ...
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    14 min