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
  • Podcast - The Heart of the Matter (Part 1): NICE Guidelines on CVD risk reduction and Lipid Modification

    Podcast - The Heart of the Matter (Part 1): NICE Guidelines on CVD risk reduction and Lipid Modification
    Oct 31 2024
    For the introductory video on cardiovascular risk reduction and lipid modification: · https://youtu.be/jIhlkmOcsiI 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 CV risk assessment, recommendations for specialist referral and considerations before starting statin therapy. In the next episode I will cover the rest of the guideline including primary and secondary prevention, assessing response to treatment, optimising therapy and what to do when statins are contraindicated or not tolerated. 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. 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-fh 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 TranscriptIf 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 CV risk assessment, recommendations for specialist referral and considerations before starting statin therapy. Stay tuned because in the next episode we will cover the rest of the guideline including primary and secondary prevention, assessing response to treatment, optimising therapy and what to do when statins are contraindicated or not tolerated. 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.For people without established cardiovascular disease, we are now advised to use QRISK3 instead of QRISK2 to calculate the CV risk within the next 10 years. We will do this for those aged between 25 and 84, including those with type 2 diabetes.Because QRISK2 is currently embedded in the electronic clinical systems that most of us use in the UK, NICE accepts that, until the clinical software systems are updated with QRISK3, it may be necessary to continue using QRISK2.However, when assessing the CV risk for people taking steroids or atypical antipsychotics or people with SLE, migraine, erectile dysfunction or severe mental illness, we are advised to use the online version of QRISK3, because QRISK2 does not take these risk factors into account and may underestimate the risk. A link to the online version of QRISK3 is in the ...
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    12 mins
  • Podcast - PSA consensus 2024 - When should you check PSA levels?

    Podcast - PSA consensus 2024 - When should you check PSA levels?
    Oct 21 2024
    For the PSA video:· https://youtu.be/64vGSs6WLws For the NICE management of male LUTS video:· https://youtu.be/fgQcv01YJg0 My name is Fernando Florido, and I am a General Practitioner in the United Kingdom. In this episode, I review the latest guidance on PSA testing as outlined in the PSA Consensus 2024, available through Prostate Cancer UK and also featured in the British Journal of General Practice. I will also discuss recommendations from Public Health England, along with key aspects of the NICE guidelines on prostate cancer (NG12 and NG131) and the Pan London urology cancer referral pathways. You can find links to all of these resources below.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 any of the institutions.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 The resources consulted can be found here:Guidance updated on PSA testing for prostate cancer by Public Health England can be found here:· https://phescreening.blog.gov.uk/2020/01/20/psa-testing-guidance/The PSA Consensus 2024 for health professionals available in Prostate Cancer UK can be found here:· https://prostatecanceruk.org/for-health-professionals/guidelines/psa-consensus-2024The article published in the British Journal of General Practice: “Optimising the use of the prostate- specific antigen blood test in asymptomatic men for early prostate cancer detection in primary care: report from a UK clinical consensus” can be found here:· https://bjgp.org/content/74/745/e534The leaflet on PSA testing and prostate cancer advice for men without symptoms of prostate disease aged 50 and over can be found here:· https://assets.publishing.service.gov.uk/media/64c3c279331a650014934e2c/PCRMP_patient_info_sheet_update_March_2022_v2.pdfThe NICE guideline on prostate cancer: diagnosis and management [NG131] can be found here:· https://www.nice.org.uk/guidance/ng131The NICE guideline on Suspected cancer: recognition and referral [NG12] can be found here:· https://www.nice.org.uk/guidance/ng12/chapter/Recommendations-organised-by-site-of-cancer#urological-cancersThe Pan-London suspected cancer referral forms can be found here:· https://www.transformationpartners.nhs.uk/programmes/cancer/early-diagnosis/two-week-wait-referral-repository/suspected-cancer-referrals/The information leaflet recommended by Public Health England for well men aged 50 and over containing a summary of the potential benefits and risks of PSA can be found here: · https://www.gov.uk/government/publications/prostate-specific-antigen-testing-description-in-briefThe NICE management of male LUTS video:· https://youtu.be/fgQcv01YJg0 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 TranscriptIf 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 latest guidance on PSA testing, as outlined in the PSA Consensus 2024, available through Prostate Cancer UK and also featured in the British Journal of General Practice. We’ll also cover recommendations from Public Health England, some aspects of the NICE guidelines on prostate cancer (NG12 and NG131), and the Pan London urology cancer referral pathways, focusing on what is relevant in Primary Care only. You can find links to all of these in the episode description.If you’d like a refresher on the NICE guidance for managing male LUTS, please refer to the corresponding episode on this channel. The link is also in the episode description.Right, let’s jump into it.Although the PSA Consensus 2024 focuses on PSA testing in asymptomatic men, we’ll also cover testing in symptomatic patients.So let’s start with patients with symptoms.While many people with prostate cancer are asymptomatic, we ...
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    13 mins
  • Podcast - NICE News - September 2024

    Podcast - NICE News - September 2024
    Oct 13 2024
    The video version of this podcast can be found here: · https://youtu.be/BnwK2Vts3gYThis 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 September 2024 by the National Institute for Health and Care Excellence (NICE), focusing on those that are relevant to Primary Care only. I also cover the guideline on Adrenal insufficiency published on 28th August 2024. 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 September 2024 can be found here:· https://www.nice.org.uk/guidance/published?from=2024-09-01&to=2024-09-31&ndt=Guidance&ndt=Quality+standardThe links to the guidance covered in this episode can be found here:Vibegron for treating symptoms of overactive bladder syndrome:· https://www.nice.org.uk/guidance/ta999Adrenal insufficiency: identification and management:· https://www.nice.org.uk/guidance/ng243The Imperial Centre for Endocrinology prednisolone withdrawal regimen can be found here:· https://www.impendo.co.uk/prednisolone/prednisolone-withdrawalIntro / 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 September 2024, focusing on what is relevant in Primary Care only. We are going to cover just two areas, the treatment of overactive bladder and the guideline on adrenal insufficiency, which was published late in August 2024 and did not make it into last month’s episode. Right, let’s get started. The first area is a technology appraisal on Vibegron for treating the symptoms of overactive bladder syndrome in adults. It is very similar to the technology appraisal on mirabegron. Before looking at the recommendation, let’s have a quick overview of Overactive bladder syndrome. It is a condition characterized by a frequent and urgent need to pass urine, sometimes with urinary incontinence. It is often caused by involuntary contractions of the bladder wall. Treatment for OAB involves lifestyle changes, behavioural therapies, and medications. NICE recommends that bladder training and lifestyle advice should be offered as first-line treatments. Then an antimuscarinic drug should be offered second-line and beta 3 agonists should be offered third line. So, let’s look at the two types of drug treatment:Antimuscarinic Agents (or Anticholinergics) are the most commonly prescribed drugs and they work by blocking muscarinic receptors in the bladder, reducing the involuntary contractions of the detrusor muscle.Examples are:OxybutyninTolterodineSolifenacinDarifenacin andFesoterodineSince muscarinic receptors are also found in other parts of the body (e.g., the salivary glands, eyes, and intestines), antimuscarinic agents can cause side effects such as dry mouth, constipation, blurred vision, and cognitive dysfunction, especially in elderly patients.Beta-3 Adrenergic Agonists are drugs like mirabegron and vibegron which offer an alternative to antimuscarinics. These drugs specifically stimulate beta-3 receptors on the detrusor muscle, causing the muscle to relax. This increases the bladder’s capacity and reduces the urgency and frequency of urination.Beta-3 agonists tend to have fewer side effects compared to antimuscarinic agents. Some common side effects are mild increases in blood pressure, arrythmias, headache, and urinary tract infections.So, in summary, the main difference between these Drug Classes are that Antimuscarinics work by reducing involuntary bladder ...
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    12 mins
  • Podcast - Sterile pyuria: and now, what?!

    Podcast - Sterile pyuria: and now, what?!
    Oct 5 2024
    The video version of this podcast can be found here:· https://youtu.be/ivCRpRFs3cgFor the non-visible haematuria video:· https://youtu.be/SaizjWg7FngFor the non-visible haematuria podcast: · https://youtu.be/bIKhn43o7ZI 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 sterile pyuria, always focusing on what is relevant in Primary Care only. The information is based on based on published medical articles in the British Journal of General Practice as well as the New England Journal of Medicine. The link to them can be found below. 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 any of the institutions.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 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:Sterile pyuria: a practical management guide - British Journal of General Practice 2016; 66 (644): e225-e227:· https://bjgp.org/content/66/644/e225Sterile Pyuria – Review article NEJM - N Engl J Med 2015; 372:1048-1054:· https://www.nejm.org/doi/10.1056/NEJMra1410052?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200www.ncbi.nlm.nih.govThe non-visible haematuria video can be found here:· https://youtu.be/SaizjWg7FngThe non-visible haematuria podcast can be found here: · https://youtu.be/bIKhn43o7ZI 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 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’m Fernando, a GP in the UK. Today we are going to go through the interpretation and initial management of sterile pyuria, always focusing on what is relevant in Primary Care only. The information is based on two relevant medical publications in the British Journal of General Practice as well as the New England Journal of Medicine. The links to them are in the episode description. If you want a reminder on how to manage non-visible haematuria, please watch the corresponding episode on this channel. The link is in the episode description too. Right, so let’s jump into it. Sterile pyuria is not an uncommon finding in clinical practice. Nine per cent of patients with lower urinary symptoms, and who are suspected of a UTI, are found to have sterile pyuria. It can be higher in specific populations and sterile pyuria is more common among women because of the higher incidence of pelvic infection. Sterile pyuria continues to pose a diagnostic conundrum because there are no guidelines on its management. Furthermore, no agreed definition for sterile pyuria exists. It is simply the presence of white blood cells in the urine, in the absence of infection. Some authors have defined it as the presence of 10 or more white cells per cubic millimetre of urine, 3 or more white cells per field on microscopy, or a urinary dipstick test that is positive for leucocytes, all of this in the absence of positive urine cultures. Sterile pyuria can also be associated with haematuria, proteinuria, and casts, complicating the diagnosis. (Causes) Looking at the cause, broadly speaking, sterile pyuria may be classified as infectious or non-infectious. Let’s look at the infectious causes first. Simple bacterial UTIs are extremely common. However, a recently treated UTI, usually within 2 weeks, or even after a single dose of antibiotics, can present as sterile pyuria. Therefore, we should check whether a recent course of antibiotics has been given and, if we are treating a UTI and requesting a urine culture, we should ensure that we advise patients to collect the urine sample before taking the first dose of antibiotics. When considering UTIs, we also need to take into account that, although colony counts greater than 100,000 colony-forming units per millilitre of urine (CFU/ml) have historically been used to diagnose a UTI, bacterial colony counts as low as 1000 colony-forming units per millilitre (CFU/ml) can be a sign of bacteriuria. So, it is important to consider that lower bacterial counts can still be associated with a urinary tract infection, even though the urine culture may be reported as negative, so ...
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    12 mins
  • 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