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diagnosis and management- NICE guideline [NG743] can be found here:· https://www.nice.org.uk/guidance/ng73Final draft guidance on Atogepant for preventing migraine [ID5090] | can be found here:· https://www.nice.org.uk/guidance/indevelopment/gid-ta10992/documentsIntro / outro music: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...
