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11 minutes | Oct 13, 2021
Ep 34 – Urinary symptoms during pregnancy
In this episode, Dr Kate Chesterman discusses the case of Lauren, a 32-year-old lady who is 30 weeks pregnant. Lauren presents with dysuria and increased frequency. Kate talks us through the current guidance on urinary symptoms in pregnancy and considers who to investigate, when to treat and what to treat with. She highlights physiological changes in pregnancy, important obstetric and non-obstetric causes for urinary symptoms as well as relevant red flags.
9 minutes | Sep 23, 2021
Ep 33 – Superficial venous thrombosis in primary care
In this episode, Kevin considers the diagnosis and management of superficial venous thrombosis. Lesley is a 64-year-old woman who presents to us with a sore, itchy right leg and no past medical history of note. On examination, she has a tender, hard, erythematous varicose vein extending from her thigh to ankle. What should we do next? Should we be worried about underlying deep vein thrombosis?
16 minutes | Sep 3, 2021
Ep 32 – Gynaecomastia: investigation and management in primary care
In this episode, Kate discusses gynaecomastia and its investigation and management in primary care. She talks us through an infographic produced by The Association of Breast Surgery called Guidance on Gynaecomastia and considers the following important questions: “who do I need to be worried about?”, “what investigations should I consider?” and “when should I make a referral?”.
22 minutes | Aug 13, 2021
Ep 31 – Diagnosing and managing Addison’s disease in primary care
In this episode, Kevin discusses the case of Louise, a 19-year-old who has been living with type 1 diabetes for the last 12 years and hypothyroidism for the last 8 years. She presents to us in primary care with a history of recurring unexplained hypoglycaemic episodes despite proactive adjustments to her insulin regimen. In addition to her insulin, she is taking levothyroxine 150 μg/day. She has not recently made significant changes to her diet or daily physical activity. Louise has also been experiencing light-headedness when rising from a sitting position. She has a BMI of 19 kg/m2, and a recent HbA1c value was 63 mmol/mol (7.9%). You record her sitting blood pressure as 119/67 mmHg and her standing value as 99/72 mmHg. You notice some patches of vitiligo on her face. What should we do next?
20 minutes | May 5, 2021
Ep 30 – Opioids and musculoskeletal pain
In this episode, which has been recorded for Chronic Conditions Month 2021, Dr Peter Bagshaw (Clinical Lead in Dementia and Mental Health, South Gloucestershire CCG) and Dr Rob Hampton (Portfolio GP, Leicester) explore the use of opioids for musculoskeletal pain and examine alternative approaches to treatment. Do opioids have a role in managing musculoskeletal pain? How are guidelines in this area evolving? In what ways is our understanding of psychosomatic contributors improving? What should GPs be looking at in consultations, especially when time is limited?
29 minutes | May 4, 2021
Ep 29 – Investigations for chronic kidney disease in primary care
In this episode, which has been recorded for Chronic Conditions Month 2021, Dr Yassir Javaid (Cardiovascular and Diabetes Clinical Lead, Nene CCG) and Dr Kevin Fernando (GP Partner at North Berwick Health Centre and Education Director for GPnotebook Education) discuss the detection of chronic kidney disease in primary care. What do the different tests tell us? What are the most up-to-date guidelines on investigations for CKD, and what do they recommend we do? How often should we be conducting tests for renal function and albuminuria?
24 minutes | May 2, 2021
Ep 28 – Mental health implications of the COVID-19 pandemic
In this episode, which has been recorded for Chronic Conditions Month 2021, Dr Steve Holmes (Clinical Respiratory Lead for NHS Somserset) and Dr Peter Bagshaw (Clinical Lead in Dementia and Mental Health, South Gloucestershire CCG) explore the impact that COVID-19 has had on mental health, including among people who have not been infected. How has self-isolation and shielding affected different people? What is the particular impact on children and younger people? What has the toll been on carers? Which people may struggle with "returning to normal"? How can we support people with "long COVID"? What is the potential role for talking therapies in this area?
30 minutes | Apr 30, 2021
Ep 27 – Managing cancer in the primary care setting
In this episode, which has been recorded for Chronic Conditions Month 2021, Dr Steve Holmes (Clinical Respiratory Lead for NHS Somserset) and Dr Anthony Cunliffe (National Lead GP Adviser at Macmillan Cancer Support) discuss cancer as a long-term condition from a primary care perspective. How is the landscape of cancer care changing, with respect to the role of primary care clinicians? Why is accurate coding so important? In what ways can clinicians better individualise care in this area? What resources are available to support difficult conversations?
31 minutes | Apr 28, 2021
Ep 26 – Severe mental illness and diabetes
In this episode, which has been recorded for Chronic Conditions Month 2021, Dr Peter Bagshaw (Clinical Lead in Dementia and Mental Health, South Gloucestershire CCG) and Dr Kevin Fernando (GP Partner at North Berwick Health Centre and Education Director for GPnotebook Education) discuss the interplay between diabetes and severe mental illness (SMI). What exactly is meant by SMI? How prevalent is mental illness in people with diabetes? What is the role of the gut–brain axis? What signs should clinicians be looking out for in spotting depression?
37 minutes | Apr 23, 2021
Ep 25 – Palpitations: when to worry, and what is the interplay with mental illness?
In this epsiode, which has been recorded for Chronic Conditions Month 2021, Dr Peter Bagshaw (Clinical Lead in Dementia and Mental Health, South Gloucestershire CCG) and Dr Yassir Javaid (Cardiovascular and Diabetes Clinical Lead, Nene CCG) discuss the management of palpitations in primary care. How can we identify those patients with palpitations who have a significant cardiac abnormality or are at risk of an adverse outcome? What are the main causes of palpitations – including those that might have a psychological basis? What are the roles of history-taking and investigations? Finally, what red flags do we need to look out for?
33 minutes | Apr 20, 2021
Ep 24 – Key considerations when prescribing steroids
Steroids are prescribed for a range of health conditions. In this podcast, which has been recorded for Chronic Conditions Month 2021, Dr Steve Holmes (Clinical Respiratory Lead for NHS Somserset) and Dr Kevin Fernando (GP Partner at North Berwick Health Centre and Education Director for GPnotebook Education) discuss the factors that primary care clinicians need to be aware of when prescribing these drugs. What are the most common side effects with steroid use? What do clinicians need to do to minimise the risk of adrenal crisis when withdrawing steroids? What should sick-day guidance look like for people on long-term steroid treatment? How vigilant do clinicians need to be for steroid-induced diabetes?
26 minutes | Apr 9, 2021
Ep 23 – Non-blanching rash in children
In her first podcast for GPnotebook, Dr Kate Chesterman discusses new evidence on the management of children with non-blanching rashes with Dr Edward Snelson. Dr Snelson is a Consultant Emergency Paediatrician at Sheffield Children’s Hospital and is the author of the blog GPpaedstips. Should we be treating every non-blanching rash as meningococcal disease, and if not, why not? What important differentials do we want to consider in children with a fever and a non-blanching rash? Can GPs safely decide which children require emergency treatment?
26 minutes | Feb 1, 2021
Ep 22 – Diagnosis and management of vertigo in primary care
In this episode, Kevin discusses the case of Lyndsey: a 44-year-old lady who presents to us in primary care with recurrent dizzy episodes over the last month. Lyndsey feels like her head is spinning. She feels nauseated with these episodes, but there is no history of vomiting. Lyndsey can walk unaided but feels very unsteady on her feet during these episodes. The dizziness can last for hours before resolving. There is no clear precipitant to these episodes, and there is no history of headache. Lyndsey denies any hearing loss or tinnitus. What should we do next?
17 minutes | Dec 17, 2020
Ep 21 – Managing unexplained high platelet counts in primary care
In this episode, Kevin discusses thrombocytosis in the context of suspected cancer. How should an unexplained high platelet count be interpreted and managed in primary care? Which cancers are most commonly associated with thrombocytosis? Aside from underlying malignancy, what are the other possible causes? What further investigations and referrals should we consider, and when?
11 minutes | Dec 1, 2020
Ep 20 – Management of non-visible haematuria (microscopic haematuria) in primary care
In this episode, Kevin looks at common questions around non-visible haematuria (NVH) – the condition formerly known as microscopic haematuria. Should we be screening for NVH? What follow-up investigations should we do for people with asymptomatic NVH? Should we change our approach for patients taking aspirin, warfarin or direct-acting oral anticoagulants (DOACs)? Finally, who should we refer and how urgently?
18 minutes | Oct 22, 2020
Ep 19 – Investigating vitamin B12 deficiency and pernicious anaemia in primary care
In this episode, Kevin examines some common questions regarding vitamin B12 deficiency. In whom should we suspect it? What investigations should be carried out in primary care? How is it associated with folate deficiency? Once a deficiency in vitamin B12 is detected, how should it be managed? Finally, what approach should be taken during the current COVID-19 pandemic, when intramuscular administration of hydroxocobalamin may be challenging?
14 minutes | Oct 8, 2020
Ep 18 – Managing the risk of drug-induced QT prolongation in primary care
In the first episode in a new season of the podcast, Kevin discusses helpful guidance on the corrected QT interval in the context of primary care prescribing. Why should we be concerned about prolongation of the QT interval? Which medications can affect QT interval? What other risk factors for QT prolongation should be considered? And for which patients should we recommend electrocardiogram monitoring?
55 minutes | Jun 25, 2020
Ep 17 – Diabetes special: round-up from the ADA 2020 virtual congress
Kevin is joined by Drs Patrick Holmes, Amrit Lamba and Amar Puttanna to discuss the key take-home points from last week’s American Diabetes Association Virtual Scientific Sessions congress.
15 minutes | May 26, 2020
Ep 16 – Diabetes and COVID-19 related mortality in England: an interview with Partha Kar
Kevin discusses the findings of NHS research on COVID-19 in people with diabetes with study author Professor Partha Kar, National Specialty Advisor – Diabetes with NHS England.
15 minutes | May 15, 2020
Ep 15 – Sick day guidance for diabetes drugs and the management of hypoglycaemia
Kevin discusses what to do with each of the commonly used classes of diabetes drugs during intercurrent illness – a topic of particular relevance during the COVID-19 pandemic. Are these medications safe to continue? If so, is dose titration required? Which of these drugs be temporarily be stopped?
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