Primary Care Guidelines Juan Fernando Florido Santana

The video version of this podcast can be found here:
https://youtu.be/dVpfeUxt8K8
This 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+standard
The 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/ng73

Final draft guidance on Atogepant for preventing migraine [ID5090] | can be found here:
·      https://www.nice.org.uk/guidance/indevelopment/gid-ta10992/documents
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 
 
Transcript
If 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 dysuria
We 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 pel

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/ng136
The 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
Worcestershire 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=1
The Worcestershire Acute Hospitals NHS Trust Hypertensive crisis flowchart can be downloaded here:
 
·      https://1drv.ms/b/s!AiVFJ_Uoigq0mRX6no6c5m3ddfEC?e=aPVQ67
NICBH 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=1
NEJM article: Acute severe hypertension:
·      https://www.nejm.org/doi/full/10.1056/NEJMcp1901117
Approach 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 
Transcript
If 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 publicati

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/ng136
Chronic kidney disease: assessment and management - NICE guideline [NG203]:
·      https://www.nice.org.uk/guidance/ng203
The 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  
Transcript
If 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 necessary

The video version of this podcast can be found here: https://youtu.be/41MH-Z-tcf8
This 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+standard
The 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/ng241
Meningitis (bacterial) and meningococcal disease: recognition, diagnosis and management- NICE guideline [NG240] can be found here:
·      https://www.nice.org.uk/guidance/ng240
Vitamin B12 deficiency in over 16s: diagnosis and management- NICE guideline [NG239] can be found here:
·      https://www.nice.org.uk/guidance/ng239
My summary of meningitis and meningococcal disease symptoms can be found here:
·      https://1drv.ms/b/s!AiVFJ_Uoigq0mRE17SGM9XfnH-0n?e=lx7zVg
2-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 
Transcript
If 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 c

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-cancers
Chronic kidney disease: assessment and management - NICE guideline [NG203]:
·      https://www.nice.org.uk/guidance/ng203
Joint 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.pdf
Assessment 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.pdf
North Central London Haematuria clinical pathway PDF:
·      https://gps.northcentrallondon.icb.nhs.uk/pathways/haematuria
Investigating painless haematuria BMJ article - BMJ 2008;337:a260:
·      https://www.bmj.com/content/337/bmj.a260
South 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  
Transcript
If 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

Podcast description 
The video version of this podcast can be found here:
https://youtu.be/IaId_nNbO-c?si=0FF7A5J7iPxocdBd
This episode refers to guidelines on the management of abnormal liver function tests by the British Society of Gastroenterology 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 of an abnormal liver function tests, 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 can be downloaded here:
·      https://1drv.ms/b/s!AiVFJ_Uoigq0mQ8MRxaNYnA1_pzh?e=H2U7rS 
The resources consulted can be found here:
BSG- British Society of Gastroenterology:
·      bsg.org.uk/clinical-resource/guidelines-on-abnormal-liver-blood-tests
·      Guidelines on the management of abnormal liver blood tests (bsg.org.uk)
o  First published on:
o  BMJ article:
o  Guidelines on the management of abnormal liver blood tests | Gut (bmj.com)
Southeast London pathway:
·      Microsoft Word - Abnormal liver function test pathway-explanatory.docx (selondonccg.nhs.uk)
North and East Devon pathway:
·      Management of Abnormal LFTs in Asymptomatic Adults - North & East (devonformularyguidance.nhs.uk)
North Bristol
·      https://www.nbt.nhs.uk/sites/default/files/Investigation%20of%20Adult%20Patients%20with%20Abnormal%20LFT%20in%20Primary%20Care.pdf
West Hampshire:
·      Liver Blood Test Pathway | GP Portal (westhampshireccg.nhs.uk)
Medscape:
·      Liver Blood Tests: How to Interpret Abnormal Results (medscape.co.uk)
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  
Transcript
If 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 of abnormal liver function tests or LFTs, including initial follow up management, always focusing on what is relevant in Primary Care only.
And for that I will summarise the British Society of Gastroenterology guidelines on LFTs. They were first published in the BMJ and the relevant links are in the episode description. Although the full guideline covers both adults and children, in today’s episode I will be focusing only on adults. 
At the end, I will also tell you how to access my summary of the recommendations, which will be based not only on the BSG but also on a number of NHS bodies in the UK. The links to them are in the episode description and it’s worth having a look as they have flowcharts and other information that you may find useful. 
Right, there is a lot of information to cover, so let’s jump into it.
The three the most common causes of liver diseas