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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 - Don’t huff and puff: NICE tips on stable COPD management

    Podcast - Don’t huff and puff: NICE tips on stable COPD management
    Jul 14 2024
    The video version of this podcast can be found here: https://youtu.be/VZMKD0bY1G8 The link to the video on COPD diagnosis can be found here:https://youtu.be/o_q8TTra3Ys 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 go through the management section of the NICE guideline [NG115] on COPD 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: · Apple podcast: https://podcasts.apple.com/gb/podcast/primary-care-guidelines/id1608821148· Spotify: https://open.spotify.com/show/2kmGZkt1ssZ9Ei8n8mMaE0?si=9d30d1993449494e· Amazon Music: https://music.amazon.co.uk/podcasts/0edb5fd8-affb-4c5a-9a6d-6962c1b7f0a1/primary-care-guidelines?ref=dm_sh_NnjF2h4UuQxyX0X3Lb3WQtR5P· Google Podcast: https://www.google.com/podcasts?feed=aHR0cHM6Ly9mZWVkcy5yZWRjaXJjbGUuY29tLzI1ODdhZDc4LTc3MzAtNDhmNi04OTRlLWYxZjQxNzhlMzdjMw%3D%3D· Redcircle: https://redcircle.com/shows/2587ad78-7730-48f6-894e-f1f4178e37c3 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 obstructive pulmonary disease in over 16s: diagnosis and management- NICE guideline [NG115]:● https://www.nice.org.uk/guidance/NG115The visual summary for the treatment of COPD can be found here:● https://www.nice.org.uk/guidance/ng115/resources/visual-summary-treatment-algorithm-pdf-6604261741The NICE technology appraisals on oseltamivir, amantadine and zanamivir to prevent and treat flu can be found here:● https://www.nice.org.uk/guidance/ta158 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 guideline on the management of stable COPD in adults, always focusing on what is relevant in Primary Care only. If you wish to know about COPD diagnosis, please see the corresponding episode on this channel. The link is in the episode description. Right, so let’s jump into it.For COPD management, once we have offered smoking cessation advice and support, we will offer inhaled therapy. Let’s have a look at the different types of inhalers. We have:· Short-acting beta2 agonists or SABAs, like salbutamol· Short-acting muscarinic antagonists or SAMAs, like ipratropium· Inhaled corticosteroids (ICS)· Long-acting muscarinic antagonists or LAMAs and· Long-acting beta2 agonists or LABAsWhen do we use the different types of inhalers? Well, these are the general rules to follow:· We will use short-acting bronchodilators, that is, either SABAs or SAMAs, as necessary, to relieve breathlessness and exercise limitation. · We will judge the effectiveness of bronchodilator therapy depending on symptom improvement, not just lung function alone. · We will not use oral corticosteroid reversibility tests to identify who should be prescribed inhaled corticosteroids, because oral steroids do not predict response to inhaled corticosteroid therapy. · We will take into account the risk of side effects (including pneumonia) of inhaled corticosteroids for COPD · Inhaled combination therapy refers to combinations of a LAMA, a LABA and inhaled corticosteroids (ICS) and · Combination therapy is recommended in confirmed COPD with SOB or exacerbations despite short-acting bronchodilatorsLet’s now look at the different combinations and when to recommend them. We will offer a LAMA+LABA combination if there are no asthmatic features or features suggesting steroid responsiveness. This includes a previous diagnosis of asthma or of atopy, a higher blood eosinophil count, ...
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    15 mins
  • NICE News - June 2024

    NICE News - June 2024
    Jul 6 2024
    The video version of this podcast can be found here: · https://youtu.be/5aV0krXAuj8This 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 June 2024 by the National Institute for Health and Care Excellence (NICE), focusing on those that are relevant to Primary Care only. Because there were no updates relevant to Primary Care, instead in this episode I will go through the current four consultations open by NICE, also focusing on aspects 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 YouTube video on the management of headaches can be found here:· https://youtu.be/6AZttMzfFr0?si=yxPcoC4legE8zS_pThe Full NICE News bulletin for June 2024 can be found here:· https://www.nice.org.uk/guidance/published?from=2024-06-01&to=2024-06-30&ndt=Guidance&ndt=Quality+standardThe links to the current consultations can be found here:Digital supported self-management technologies for adults with chronic obstructive pulmonary disease: early value assessment:· https://nice.us8.list-manage.com/track/click?u=7864f766b10b8edd18f19aa56&id=9f762dc422&e=03ed9b0dd012 SQ-HDM SLIT for treating allergic rhinitis and allergic asthma caused by house dust mites:· https://nice.us8.list-manage.com/track/click?u=7864f766b10b8edd18f19aa56&id=501af7f75a&e=03ed9b0dd0Meningitis (bacterial) and meningococcal disease update:· https://nice.us8.list-manage.com/track/click?u=7864f766b10b8edd18f19aa56&id=4baddb7b5d&e=03ed9b0dd0Asthma: diagnosis, monitoring and chronic asthma management:· https://nice.us8.list-manage.com/track/click?u=7864f766b10b8edd18f19aa56&id=d7e86c9fd8&e=03ed9b0dd0Intro / 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 were supposed to look at the NICE updates relevant to Primary Care published in June 2024. However, this month we have had no new guidance relevant to primary care, as they were all connected to secondary care such as surgical techniques, chemotherapy agents, and acute myeloid leukaemia, amongst others.So, instead, we are going to look forward and review the guidelines that are under consultation, which will lead to new or updated guidance in the coming months. Because they are in draft form, we will only give them a quick overview. They are only four areas, so today will be a brief episode. So, let’s jump into it.The first consultation is on House Dust Mite Sublingual Immunotherapy, for treating allergic rhinitis and allergic asthma caused by house dust mites. This is referred to by NICE as 12 SQ HDM SLIT, which is a tablet, also known as Acarizax, which has already been authorised by European regulatory authorities. Let’s have a look at some key points:It is recommended for:HDM-Induced Allergic Asthma that is not well-controlled by inhaled steroids andMild to severe HDM Allergic Rhinitis but it’s onlyApproved for adults aged 18 to 65 years of ageFrom a patient perspective these conditions can be debilitating, and they have an impact on daily life. Although there are other treatments available, their management can be challenging when triggers are unexpected or outside people’s control.HDM SLIT (House Dust Mite Sublingual Immunotherapy) involves the administration of allergens (in this case, house dust mites) under the tongue to desensitise the immune system to these allergens, reducing symptoms over time.It is done using a sublingual tablet that dissolves under the tongue. The ...
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    6 mins
  • Podcast - Is this COPD? - NICE on COPD diagnosis

    Podcast - Is this COPD? - NICE on COPD diagnosis
    Jun 28 2024
    The video version of this podcast can be found here: https://youtu.be/o_q8TTra3Ys 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 section on diagnosis and initial assessment of the NICE guideline [NG115] on COPD 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: · Apple podcast: https://podcasts.apple.com/gb/podcast/primary-care-guidelines/id1608821148· Spotify: https://open.spotify.com/show/2kmGZkt1ssZ9Ei8n8mMaE0?si=9d30d1993449494e· Amazon Music: https://music.amazon.co.uk/podcasts/0edb5fd8-affb-4c5a-9a6d-6962c1b7f0a1/primary-care-guidelines?ref=dm_sh_NnjF2h4UuQxyX0X3Lb3WQtR5P· Google Podcast: https://www.google.com/podcasts?feed=aHR0cHM6Ly9mZWVkcy5yZWRjaXJjbGUuY29tLzI1ODdhZDc4LTc3MzAtNDhmNi04OTRlLWYxZjQxNzhlMzdjMw%3D%3D· Redcircle: https://redcircle.com/shows/2587ad78-7730-48f6-894e-f1f4178e37c3 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 obstructive pulmonary disease in over 16s: diagnosis and management- NICE guideline [NG115]:● https://www.nice.org.uk/guidance/NG115The visual summary for the treatment of COPD can be found here:● https://www.nice.org.uk/guidance/ng115/resources/visual-summary-treatment-algorithm-pdf-6604261741The COPD Assessment Test score or CAT score can be found here:● https://www.catestonline.org/hcp-homepage/clinical-practice.htmlThe 6-minute walk test calculator can be found here:● https://www.omnicalculator.com/health/6-minute-walk-testIntro / 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 diagnosis and initial assessment of COPD in adults according to the NICE guideline [NG115], always focusing on what is relevant in Primary Care only. I will be creating further episodes on the management of stable COPD and COPD exacerbations so stay tuned. Right, so let’s jump into it.The diagnosis of COPD is suspected on the basis of symptoms and signs and is confirmed by spirometry.So, we should suspect COPD in people over 35 who have a risk factor (generally smoking or a history of smoking) and who present with 1 or more of the following symptoms:· exertional SOB· chronic cough · regular sputum · wheezing and · frequent so-called winter 'bronchitis'As part of our assessment, we will also check for signs such as:· weight loss· reduced exercise tolerance and fatigue· waking at night with breathlessness and· ankle swellingChest pain and haemoptysis, are uncommon symptoms in COPD and they should raise the possibility of alternative diagnoses. The Medical Research Council or MRC dyspnoea scale should be used to grade the breathlessness, so let’s have a look at it:· Grade 1 is when the patient is not troubled by breathlessness except on strenuous exercise· Grade 2 is when the patient develops shortness of breath when hurrying or walking up a slight hill· Grade 3 is when the patient walks slower than contemporaries on level ground because of breathlessness, or has to stop for breath when walking at own pace· Grade 4 is when the patient stops for breath after walking about 100 metres or after a few minutes on level ground and · Grade 5 is when the patient is too breathless to leave the house, or breathless when dressing or undressingOnce we have suspected COPD, we should confirm it with spirometry. So, spirometry should definitely be done:· At diagnosis; but it can also be ...
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    14 mins
Physical Illness & Disease Hygiene & Healthy Living
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