Primary Care Guidelines Juan Fernando Florido Santana

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  
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 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‑proBNP
High 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 doub

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/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
 
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 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-blocker
The correct answer is: 
ACE inhibitor or ARB
NICE 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 origin
What is recommended regarding lifestyle advice fo

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