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 - Understanding low sodium: further assessment and management

    Podcast - Understanding low sodium: further assessment and management
    Sep 26 2024
    The video version of this podcast can be found here: · https://youtu.be/j1mnA-jOi1AThis episode makes reference to guidelines produced by North Bristol NHS Trust, Royal United Hospitals Bath NHS Trust and Royal Cornwall Hospitals NHS Trust. 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 them.My name is Fernando Florido and I am a General Practitioner in the United Kingdom. In this episode I go through the guidelines on hyponatraemia produced by North Bristol NHS Trust, Royal United Hospitals Bath NHS Trust and Royal Cornwall Hospitals NHS Trust, focusing on what is relevant to Primary Care only. Other guidance has also been consulted and links to all of them can be found below 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 links to the Hyponatraemia guidelines consulted can be found here:North Bristol NHS Trust · https://www.nbt.nhs.uk/sites/default/files/Hyponatraemia%20in%20Primary%20Care.pdfRoyal United Hospitals Bath:· https://www.ruh.nhs.uk/pathology/documents/clinical_guidelines/PATH-019_hyponatraemia_in_primary_care.pdfRoyal Cornwall Hospitals NHS trust:· https://doclibrary-rcht.cornwall.nhs.uk/DocumentsLibrary/RoyalCornwallHospitalsTrust/Clinical/EndocrineAndDiabetes/ManagementOfHyponatraemiaClinicalGuideline.pdfGreater Glasgow and Clyde:· https://handbook.ggcmedicines.org.uk/media/1099/195-hyponatraemia-flowchart-1-final-200717e.pdfGloucestershire hospitals NHS Trust · https://www.gloshospitals.nhs.uk/media/documents/Hyponatraemia.pdfIntro / 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 are looking at the further assessment and management of hyponatraemia, I have looked at the guidelines produced by North Bristol NHS Trust, and Royal United Hospitals Bath NHS Trust, as well as other guidance, focusing on what is relevant to Primary Care only. The links to the sources consulted are in the episode description. If you have not already done so, I recommend that you look at the previous episode on hyponatraemia, its classification, clinical presentation, pathophysiology and causes, which will give you a good introduction. Right, without further ado, let’s get started. Let’s have a look at the management of hyponatraemia. · As we have know, acute or severe hyponatraemia can be a medical emergency and we should admit for hospital treatment anyone with either symptoms or severe hyponatraemia, understood to be a sodium below 125. · People with asymptomatic mild hyponatraemia, that is, a sodium of between 130 and 135, can be investigated and initially managed in Primary Care. · But, what do we do with people who are asymptomatic and who have moderate hyponatraemia, that is, a sodium of between 125 and 129? Well, these people need careful assessment because there may be a risk of the sodium falling quickly. So, in these cases, we should seek specialist advice in respect of admission or referral. Let’s now look at the management in Primary Care. And as a precaution, all patients with new onset hyponatraemia should have a repeat sodium checked after one week to exclude a rapidly decreasing level. We should then assess the volume status to see if there is fluid overload or hypovolaemia. We will look at a useful flowchart later which will give us more information in that respect. We should then review the medication and, if it could be the cause, if possible, we will stop it and repeat the sodium levels in 1-2 weeks. If the sodium level remains low after stopping the medication, we should seek specialist advice. Of course, if the medication cannot safely be stopped, then we will discuss with the prescribing consultant....
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    10 mins
  • Podcast - Understanding low sodium—causes, symptoms and classification

    Podcast - Understanding low sodium—causes, symptoms and classification
    Sep 18 2024
    The video version of this podcast can be found here: · https://youtu.be/JxNOCJZP10MThis episode makes reference to guidelines produced by North Bristol NHS Trust, Royal United Hospitals Bath NHS Trust and Royal Cornwall Hospitals NHS Trust. 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 them.My name is Fernando Florido and I am a General Practitioner in the United Kingdom. In this episode I look at hyponatraemia, its classification, clinical presentation, pathophysiology and causes. I have looked at the guidelines produced by North Bristol NHS Trust, and Royal United Hospitals Bath NHS Trust, as well as other guidance, focusing on what is relevant to Primary Care only. The links to the sources consulted can be found below. 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 links to the Hyponatraemia guidelines consulted can be found:North Bristol NHS Trust · https://www.nbt.nhs.uk/sites/default/files/Hyponatraemia%20in%20Primary%20Care.pdfRoyal United Hospitals Bath:· https://www.ruh.nhs.uk/pathology/documents/clinical_guidelines/PATH-019_hyponatraemia_in_primary_care.pdfRoyal Cornwall Hospitals NHS trust:· https://doclibrary-rcht.cornwall.nhs.uk/DocumentsLibrary/RoyalCornwallHospitalsTrust/Clinical/EndocrineAndDiabetes/ManagementOfHyponatraemiaClinicalGuideline.pdfGreater Glasgow and Clyde:· https://handbook.ggcmedicines.org.uk/media/1099/195-hyponatraemia-flowchart-1-final-200717e.pdfGloucestershire hospitals NHS Trust · https://www.gloshospitals.nhs.uk/media/documents/Hyponatraemia.pdfIntro / 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 are looking at hyponatraemia, its classification, clinical presentation, pathophysiology and causes. I have looked at the guidelines produced by North Bristol NHS Trust, and Royal United Hospitals Bath NHS Trust, as well as other guidance, focusing on what is relevant to Primary Care only. The links to the sources consulted are in the episode description. The next episode will be on the further assessment and management of hyponatraemia so make sure not to miss it.Right, without further ado, let’s get started.Hyponatraemia tends to be more common in the elderly, in patients admitted, in those with a history of alcohol excess and in patients treated with thiazide diuretics. It is associated with complications such as seizures and increased mortality and, the risk increases with the severity of hyponatraemia. So, starting with the basics, what is hyponatraemia? Well, the normal range of sodium is from 135 to 145 mmol/L so hyponatraemia, that is a low sodium, is when the sodium is below 135. However, guidelines in North Bristol and Bath define it as a sodium below 133 mmol/l, so we should always look at our local path lab reference range. The severity of hyponatraemia can be classified into mild, moderate and severe. NICE recommends the following thresholds:· Mild is when the sodium is between 130-135· Moderate is when the sodium is between 125-129 and· Severe is when the sodium is less than 125 However, other guidelines give different thresholds. For example, in Bath severe hyponatraemia is below 120 and in North Bristol is below 115. But, from a primary care perspective, it will be better to err on the side of caution so we will stick to 125. This is a very important for us because we are advised to admit to hospital patients with severe hyponatraemia, as well as those who are symptomatic, irrespective of the sodium levels. And what are the symptoms of hyponatraemia? The primary symptoms are due to cellular swelling, particularly in the brain, because of the osmotic movement of water into cells in response to low sodium levels. The brain is ...
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    11 mins
  • Podcast - NICE News - August 2024

    Podcast - NICE News - August 2024
    Sep 8 2024
    The video version of this podcast can be found here: · https://youtu.be/SA7pJQLlmvgThis 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 August 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 August 2024 can be found here:· https://www.nice.org.uk/guidance/published?from=2024-08-01&to=2024-08-31&ndt=Guidance&ndt=Quality+standard The links to the current guidance can be found here:Diabetic retinopathy: Management and monitoring:· https://www.nice.org.uk/guidance/ng242Abaloparatide for treating osteoporosis after menopause:· https://www.nice.org.uk/guidance/ta991National Osteoporosis Guideline Group (NOGG) clinical guideline for the prevention and treatment of osteoporosis:· https://www.nogg.org.uk/full-guidelineIntro / 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 are looking at the NICE updates published in August 2024, focusing on what is relevant to Primary Care only. We are going to cover just two areas, the treatment of osteoporosis and the management of diabetic retinopathy, so it is a brief episode. Let’s jump into it. The first area is a technology appraisal on Abaloparatide for treating osteoporosis after the menopause.And you may be thinking, Abaloparatide, is this really something that we need to know about in Primary Care?And the answer is yes. And let’s see why.And we will start by saying that treatments of osteoporosis can be broadly divided into 2 types:· antiresorptive treatments (which slow the rate of bone breakdown), such as our usual bisphosphonates and· anabolic (or bone-forming) treatments.Treatment with anabolic skeletal agents result in rapid and greater fracture risk reductions than bisphosphonates. So, if we are used to prescribing bisphosphonates for the majority of our patients, who should be getting anabolic agents instead? And the guidelines stipulate that people with a very high fracture risk should be referred for the consideration of these agents. According to the National Osteoporosis Guideline Group, 'very high risk' is defined as a FRAX-based fracture probability that exceeds the intervention threshold by 60%. So, looking at this diagram based on FRAX, we can see how patients can fall into the different risk categories depending on their scores. Apart from the patients already in the very high risk of fractures, we should also consider additional clinical risk factors for patients in the high-risk category, (e.g., frequent falls, or a very low spine Bone Mass Density) in case that they may move them from high to very high risk of fracture. So, in summary, we need to be aware that these anabolic drugs exist and that they are recommended for people with a very high risk of fractures so that when we see such patients, we refer them appropriately to get these drugs.Existing anabolic treatments are Romosozumab and Teriparatide and, following this technology appraisal, NICE recommends Abaloparatide too. These anabolic agents can only be taken for a limited time between 12 and 24 months depending on the drug, and afterwards patients will continue to receive an antiresorptive treatment (such as an oral bisphosphonate). Although abaloparatide is licensed for 'treatment of osteoporosis in postmenopausal women', we must also include ...
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    7 mins
Physical Illness & Disease Hygiene & Healthy Living
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