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 - Kidneys on the Edge (Part 1): Understanding AKI

    Podcast - Kidneys on the Edge (Part 1): Understanding AKI
    Nov 20 2024
    The video version of this podcast can be found here: · https://youtu.be/k6amIFy84BcThis 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 go through the NICE guideline on acute kidney injury, NG148, focusing on what is relevant to Primary Care only, covering the diagnosis, and investigations, as well as the recommendations on the use of contrast media. In the next episode we will cover the management recommendations by NICE, and the Primary Care flowchart on AKI by Barnsley Hospital NHS Trust and King’s College Hospital NHS Trust, so stay tuned. 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. 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 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 links to the guidance covered in this episode can be found here: Acute kidney injury: prevention, detection and management (NG148):· https://www.nice.org.uk/guidance/ng148The 1-page visual summary on assessing the risk of acute kidney injury in adults having iodine-based contrast media: outpatient, non-urgent inpatient and community settings:· https://www.nice.org.uk/guidance/ng148/resources/visual-summary-pdf-13551376429The algorithm for early identification of acute kidney injury, endorsed by NHS England:· https://www.england.nhs.uk/akiprogramme/aki-algorithm/The Management of acute kidney injury in adults in Primary Care by Barnsley Hospital NHS Trust: · https://best.barnsleyccg.nhs.uk/media/hruaaymn/best-december-2015-barnsley-aki-primary-careguidance-pathway.pdf?form=MG0AV3The Adult Acute Kidney Injury Care Pathway for Primary Care by King’s College Hospital NHS Trust:· https://www.kch.nhs.uk/wp-content/uploads/2023/01/mi-169.2-adult-acute-kidney-injury-care-pathway.pdfA calculator for the National Early Warning Score (NEWS):· https://www.mdcalc.com/calc/1873/national-early-warning-score-newsTranscriptIf 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 will go through the NICE guideline on acute kidney injury focusing on what is relevant in Primary Care only. In this episode, we will cover the diagnosis, and investigations, as well as the recommendations on the use of contrast media. In the next episode we will cover the management recommendations by NICE, and the Primary Care flowchart on AKI by Barnsley Hospital NHS Trust and King’s College Hospital NHS Trust, so stay tuned. Right, let’s jump into it. In order to identify acute kidney injury, we will check serum creatinine and compare it with baseline. AKI is most often seen during episodes of acute illness so we should do this screening in people with acute illness if there is: Pre-existing CKD (or eGFR less than 60)heart failureliver diseasediabeteshistory of acute kidney injuryoliguria (that is, a urine output less than 0.5 ml/kg/hour)neurological or cognitive impairment or disability, which may mean limited access to fluids hypovolaemiause of certain drugs such as NSAIDs, aminoglycosides, ACE inhibitors, ARBs and diuretics within the past week, especially if hypovolaemicuse of iodine-based contrast media within the past weeksymptoms or risk of urological obstruction, sepsisdeteriorating early warning scores andyoung age or age 65 years or over In addition, for children and young people we should also screen for AKI if there is:severe diarrhoea (particularly bloody diarrhoea)symptoms or signs of nephritis (such as oedema or haematuria)haematological malignancy andhypotensionHowever, AKI can also happen in the absence of an acute illness. So, if there is a rise in serum creatinine, we should still consider AKI ...
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    9 mins
  • Podcast - NICE News - October 2024

    Podcast - NICE News - October 2024
    Nov 13 2024
    The video version of this podcast can be found here: · https://youtu.be/hN5JRXItBJ4This 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 go through new and updated recommendations published in October 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. 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 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 October 2024 can be found here:· https://www.nice.org.uk/guidance/published?from=2024-10-01&to=2024-10-31&ndt=Guidance&ndt=Quality+standardThe links to the guidance covered in this episode can be found here: Digital technologies for assessing attention deficit hyperactivity disorder (ADHD):· https://www.nice.org.uk/guidance/dg60Acute kidney injury: prevention, detection and management:· https://www.nice.org.uk/guidance/ng148The 1-page visual summary on assessing the risk of acute kidney injury in adults having iodine-based contrast media: outpatient, non-urgent inpatient and community settings:· https://www.nice.org.uk/guidance/ng148/resources/visual-summary-pdf-13551376429TranscriptIf 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 October 2024, focusing on what is relevant in Primary Care only. Although most of the updates do not really relate to Primary Care, there were two areas that I found particularly interesting and relevant to us, ADHD and acute kidney injury.Right, let’s get started. We will start with digital technologies for assessing ADHD. Let’s remember that attention deficit hyperactivity disorder (or ADHD) is a neurodevelopmental condition characterised by a persistent pattern of hyperactivity, impulsivity, and inattention that interferes with daily and occupational functioning.As a result, people with ADHD may make important decisions hastily without considering the long-term consequences.Treatment may be non-pharmacological, including psychoeducation, ADHD coaching, or environmental changes. Pharmacological treatment may include stimulant or non-stimulant medication. There is a perception that recently there has been a huge increase in the demand for ADHD services because of an increased awareness of this condition. The global prevalence of ADHD in children is estimated to be around 5% and, in the UK, the prevalence of ADHD in adults is estimated to be between 3% and 4%, being more commonly diagnosed in males than females.Following the current care pathway, people with suspected ADHD are referred to secondary care for assessment, which is based on clinical judgement, relying on information obtained from a range of sources. However, information from these sources may often be incomplete or contradictory, and the diagnosis may be further complicated due to an overlap with other disorders and mental health conditions, which usually causes an extended delay in reaching a diagnostic decision. This is why, many digital technologies have been developed to assist in the diagnosis, which could reduce patient waiting lists and free up NHS resources. And it is precisely these digital technologies that have been assessed by NICE.And one of these technologies is called the QbTest.What is the QbTest?Well, the QbTest has certain elements comparable to a computer game which measures the core symptoms of ADHD, that is, attention, impulsivity, and hyperactivity. Results from the test are compared with people without ADHD and the results are ...
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    8 mins
  • Podcast - The Heart of the Matter (Part 2): NICE Guidelines on CVD risk reduction and Lipid Management

    Podcast - The Heart of the Matter (Part 2): NICE Guidelines on CVD risk reduction and Lipid Management
    Nov 7 2024
    For the introductory video on cardiovascular risk reduction and lipid modification: · https://youtu.be/jIhlkmOcsiI For the second video on cardiovascular risk reduction and lipid modification: · https://youtu.be/QyN3toBGCNU For the NICE guidance on cardiac chest pain video: · https://youtu.be/so97zARpmME For the NICE management of stable angina video: · https://youtu.be/BtWs0VHjp00 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 review the NICE guideline “Cardiovascular disease: risk assessment and reduction, including lipid modification” [NG238], published on 14 December 2023, focusing on what is relevant in Primary Care only. I cover statins for both primary and secondary prevention, assessing response to treatment, optimising therapy and what to do when statins are contraindicated or not tolerated. If you have not already done so, I recommend my previous introductory video on the subject covering CVD risk assessment, recommendations for specialist referral and considerations before starting statin therapy. The link is shown above. For a refresher on the NICE guidance on cardiac chest pain and the management of stable angina, please refer to the corresponding episodes on this channel. The links are shown above. 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. 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 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:The NICE guideline “Cardiovascular disease: risk assessment and reduction, including lipid modification” [NG238] Published: 14 December 2023 can be found here:· https://www.nice.org.uk/guidance/ng238The online version of QRISK3 can be found here:· https://qrisk.org/The QRISK3-lifetime tool can be found here:· https://qrisk.org/lifetime/index.phpThe NICE guideline on familial hypercholesterolaemia can be found here:· https://www.nice.org.uk/guidance/cg71The Simon Broome criteria for the diagnosis of familial hypercholesterolaemia can be found here:· https://www.nice.org.uk/guidance/cg71/evidence/full-guideline-appendix-f-pdf-241917811The Dutch Lipid Clinic Network (DLCN) criteria for the diagnosis of familial hypercholesterolaemia can be found here:· https://www.mdcalc.com/calc/3818/dutch-criteria-familial-hypercholesterolemia-fhTranscriptIf you're 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’ll look at the NICE guideline on cardiovascular risk reduction and lipid modification, or NG238, which was published in December 2023, focusing on what is relevant in Primary Care only. In this episode we are going to cover statins for both primary and secondary prevention, assessing response to treatment, optimising therapy and what to do when statins are contraindicated or not tolerated. If you have not already done so, I recommend that you listen to the previous introductory episode on the subject covering CV risk assessment, recommendations for specialist referral and considerations before starting statin therapy. The link is in the episode description. If you’d like a refresher on the NICE guidance on cardiac chest pain and the management of stable angina, please refer to the corresponding episodes on this channel. The links are also in the episode description. Right, let’s jump into it. We are going to start reviewing the prescribing of statins for the primary prevention of cardiovascular disease. And, before offering a statin, we will discuss the benefits of lifestyle changes and optimise the management of all other modifiable CVD risk factors if possible. Then, if lifestyle changes are not sufficient, we will offer statin treatment. Equally, before starting statins, we will treat comorbidities and secondary causes of dyslipidaemia, which include, for example, excess alcohol, uncontrolled diabetes, hypothyroidism, liver ...
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    12 mins

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