Primary Care Knowledge Boost Primary Care Knowledge Boost

**Summer Rewind: This episode was first released on Nov 30th 2022**
Doctors Lisa and Sara talk to Consultant Otolaryngologist Ms Emma Stapleton and Clinical Scientist David Jay about Vertigo. We discuss the definition, differentials, and how to use information around timing and triggers to differentiate between the likely causes of vertigo. We get their take on the important details in the examination that can help identify the diagnosis, and talk options for managing the most common types of peripheral vertigo.
The resources section of the episode description contains excellent resources to help, including examples of how to perform and interpret the Head Impulse test, as well as vestibular rehabilitation resources for patients. 
You can use these podcasts as part of your CPD - we don’t do certificates but they still count :)
Useful resources: 

HINTS to diagnose stroke in the acute vestibular syndrome: three-step bedside oculomotor examination more sensitive than early MRI diffusion-weighted imaging. Kattah JC, Talkad AV, Wang DZ, Hsieh YH, Newman-Toker DE . Nov 2009, Stroke: https://pubmed.ncbi.nlm.nih.gov/19762709/


A summary of HINTS by David Jay: Developments in diagnostic approaches for acutely dizzy patients: (Feb 2020 ENT & Audiology News): https://www.entandaudiologynews.com/features/audiology-features/post/developments-in-diagnostic-approaches-for-acutely-dizzy-patients


TiTrATE: A Novel Approach to Diagnosing Acute Dizziness and Vertigo. Newman-Toker and Edlow J A. Neurology Clinics (Aug 2015)  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4522574/


The Five Deadly D’s of Dizziness (red flags to remember): EM Resident, Unravelling the Mystery of Dizziness in the ED: A Guide for the Student Clerkship, Oct 2018 Wilcox K, Shafer K: https://www.emra.org/emresident/article/dizziness/


BMJ Vertigo: Dix-Hallpike Video: https://www.youtube.com/watch?v=8RYB2QlO1N4


BMJ Vertigo: Epley Manoeuvre Video: https://www.youtube.com/watch?v=jBzID5nVQjk&t=44s


Examples of how to perform the Head Impulse Test for Peripheral Vestibular Dysfunction:

            https://www.youtube.com/watch?v=psyPED6anPo
            https://www.youtube.com/watch?v=XpghlvnrREI

Professor Lucy Yardley: Retraining your Balance: https://www.menieres.org.uk/files/pdfs/balance-retraining-2012.pdf


VeDA Vestibular Disorders Association USA Resources for Clinicians and Patients: Main Page: https://vestibular.org/


VeDA Vestibular Disorders Association USA Resources for Clinicians and Patients: Type of Vestibular Disorders Page: https://vestibular.org/article/diagnosis-treatment/types-of-vestibular-disorders/


Meniere’s Society UK: https://www.menieres.org.uk/


The Migraine Trust: https://migrainetrust.org/

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We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://pckb.org/feedback
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This podcast has been made with the support of GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions. 
The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen.
Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue a

Doctors Lisa and Sara speak with GP Dr Allison Rees for her advice on how to approach GP Appraisals and Revalidation. We heard her talk about this in a Health Education England First Five talk a few years ago and found it so helpful. We cover why they can be useful, the practicalities of what needs to be done and how to make them work for you. 
You can use these podcasts as part of your CPD - we don’t do certificates but they still count :)
Useful resources: 
RCGP Guide to your Appraisal: https://www.rcgp.org.uk/your-career/revalidation/supporting-information-guidance
Advice and Guidance for Locum Doctors and Doctors in Short Term Placements: https://www.england.nhs.uk/professional-standards/medical-revalidation/doctors/locum-ad/
RCGP Appraisal and Revalidation Mythbusters: https://www.rcgp.org.uk/your-career/revalidation/mythbusters
NHS England Greater Manchester GP Fellowship scheme for GPs within 2 years of Qualifying: https://www.gmthub.co.uk/our-programmes/gp-fellowship
New to Practice Health Education England Fellowship: https://madeinheene.hee.nhs.uk/general_practice/Primary-Care-Training-Hub/GP-GPN-Fellowship-Programme/New-to-Practice-Fellowships
The Revalidation Management System (RMS): https://rms.england.nhs.uk/Account/Login?ReturnUrl=%2f
Medical Appraisal Guide 2022: https://www.aomrc.org.uk/wp-content/uploads/2022/06/Medical_Appraisal_Guide_2022_0622.pdf
National Association of Sessional GPs: https://www.nasgp.org.uk/
The General Medical Practice Framework for Appraisal and Revalidation: https://www.gmc-uk.org/-/media/documents/The_Good_medical_practice_framework_for_appraisal_and_revalidation___DC5707.pdf_56235089.pdf
___
We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://pckb.org/feedback
___
This podcast has been made with the support of GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions. 
The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen.
Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk.
The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Doctors Sara and Lisa talk to Dr Wasim Javed, ST6 in Cardiology, about the diagnosis and management of Angina. Taking a theoretical case we talk through symptoms, differentials, diagnosis, including the guidelines and practicalities of different types of functional and non-functional tests, as well types of angina and their management. It was useful to understand the initial management once diagnosed, and where further investigations or referrals/discussions with cardiology come in. As well as the above, we discuss the difference between medical management and stenting and some of the third line anti-anginal medications. 
You can use these podcasts as part of your CPD - we don’t do certificates but they still count :)
Useful resources: 
NICE guidelines on Stable Angina (updated July 2016): https://www.nice.org.uk/guidance/cg126
European Society of Cardiology 2019 Guideline on Chronic Coronary Syndromes: https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Chronic-Coronary-Syndromes
Life in the Fast Lane (ECG interpretations etc): https://litfl.com/library/
Traffic Light System for Primary Care Prescribing in Greater Manchester (contains information on what should be started by Specialists etc): https://gmmmg.nhs.uk/rag-category/adult/
___
We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://pckb.org/feedback
___
This podcast has been made with the support of GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions. 
The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen.
Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk.
The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Doctors Sara and Lisa talk to talk to Dr Mary Cheshire who is the GP lead on the NHS England Fellowships for Greater Manchester GPs. As she explains, this is a fairly informal fellowship done over 2 years offering different types of courses and support that essentially consists of a paid CPD session a week and a range of CPD events to facilitate this. The course runs a qualification in coaching people can sign up for and are offered Mentors. Completing a quality improvement project is encouraged, whether that is small or large and there are opportunities for support for this along the way. At the moment this is available for newly qualified GPs and those up to 2 years after CCT who are in Salaried or Partnership posts. 
There are other types of Fellowships - we mention the Health Education England GP Fellowships and GP Nurses Fellowships briefly, see details below. 
You can use these podcasts as part of your CPD - we don’t do certificates but they still count :)
Useful resources: 
The Greater Manchester Training Hub GP Fellowship Information: https://www.gmthub.co.uk/our-programmes/gp-fellowship
Links to information about the GP Fellowship, the GP Nurse Fellowship, Primary Care Mentoring and a course for clinicians New to Primary Care:https://www.gmthub.co.uk/our-programmes
For Questions about the Fellowship and how it works that aren’t answered in the links above: rob.harris4@nhs.net
Health Education England GP Fellowships: https://www.nwpgmd.nhs.uk/post-cct-gp-fellowship-programme-hee-nw
___
We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://pckb.org/feedback
___
This podcast has been made with the support of GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions. 
The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen.
Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk.
The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Doctors Sara and Lisa talk to talk to GP and Professor of General Practice Research Dr Carolyn Chew-Graham about the current landscape of Long COVID three years on. She spoke to us on the topic back in August 2021, but what we know and some of the treatments have moved on from then. In this talk we discuss why the patient-preferred term is Long COVID rather than Post COVID Syndrome, symptoms, how many people are living with the condition in the UK to date and some of the types of management and help that are available. 
You can use these podcasts as part of your CPD - we don’t do certificates but they still count :)
Useful resources: 
Your COVID Recovery Website: https://www.yourcovidrecovery.nhs.uk/
Interviews with Patients with Long COVID: https://healthtalk.org/Long-Covid-In-Adults/overview
Postural Orthostatic Tachycardia Syndrome:
https://www.potsuk.org
 https://www.potsuk.org/gp_guide

BMJ Article on Orthostatic Tachycardia with Infographic Mentioned (March 2023): https://www.bmj.com/content/378/bmj-2022-072117
Information on Mastocytosis and Mast Cell Activation Syndrome:
https://ukmasto.org/#gsc.tab=0
https://www.potsuk.org/about-pots/associated-conditions/mcas/

Greater Manchester Long COVID Support Group: https://hsm.manchester.gov.uk/kb5/manchester/directory/service.page?id=Rn19N5XSimc
UK Long COVID Support Group: https://www.longcovid.org/
Support Groups for Families with a Child with Long COVID: https://www.longcovidkids.org/
Advice for Supporting a Child with Long COVID: https://theconversation.com/supporting-a-child-with-long-covid-tips-from-parents-of-children-living-with-the-condition-195153
Research on Impact of Long COVID on Racially Minoritised Groups: https://blog.westminster.ac.uk/hicovestudy/
Research on whether existing Medications have any Impact on Long COVID ‘STIMULATE ICP’: https://www.stimulate-icp.org/
LOCOMOTION Study looking at Optimising Treatments in Long COVID: https://bmjopen.bmj.com/content/12/5/e063505
Be Part of Research: What Trials are available (here for people with Long COVID): https://bepartofresearch.nihr.ac.uk/results/search-results?query=long%20covid&location=
National Institute for Health and Care Research: https://www.nihr.ac.uk/patients-carers-and-the-public/i-want-to-take-part-in-a-study.htm
Resources around advice for Returning to Work:
https://www.som.org.uk/take-planned-approach-managing-long-covid-workforce-new-som-guide
 https://www.fom.ac.uk/wp-content/uploads/longCOVID_guidance_04.pdf
 https://bjgp.org/content/71/712/508

NICE RCGP SIGN Guidance on Managing Patients with Long COVID (Last Updated Nov 2021): https://www.nice.org.uk/guidance/ng188
RCGP Online eLearning Module on Long COVID: https://elearning.rcgp.org.uk/course/view.php?id=492
___
We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://pckb.org/feedback
___
This podcast has been made with the support of GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions. 
The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen.
Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pur

Doctors Sara and Lisa talk to GP Dr Adam Cliffe about how he and his practice went about changing the model by which patients access the practice. It is so far working very well for both staff and patients. It’s an interesting talk about change management and one example of how a difficult situation was changed for the better. 
You can use these podcasts as part of your CPD - we don’t do certificates but they still count :)
Useful resources: 
House of Commons Committee Report: The Future of General Practice Oct 2022: https://publications.parliament.uk/pa/cm5803/cmselect/cmhealth/113/report.html#heading-0
The King’s Fund, Innovative Models for General Practice June 2018: https://www.kingsfund.org.uk/publications/innovative-models-general-practice
___
We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://pckb.org/feedback
___
This podcast has been made with the support of GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions. 
The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen.
Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk.
The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.