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Primary Care Guidelines

By: Juan Fernando Florido Santana
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  • Summary

  • A podcast intended for healthcare professionals wanting to keep up to date relevant information about clinical practice guidelines
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Episodes
  • 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 mins
  • 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 hr and 5 mins
  • 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 mins
Physical Illness & Disease Hygiene & Healthy Living
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