Recent Posts by Louise Hudman

Obstetric cholestasis

This is a good overview of the condition. Remember – it is a diagnosis of exclusion. Features: Pruritus without a rash (except excoriation). It is often worse at night and affects palms and soles too. Cholestatic symptoms (pale stool / dark urine / jaundice) Deranged LFT (transaminases / gamma-GT – bilirubin and bile acids may also be…
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Common mental health disorders

This is mainly an amalgamation of advice about spotting, assessing and managing people with common mental health disorders. There is little that I could spot that was new, apart from encouraging use of the GAD2 questionnaire in screening for anxiety: During the past four weeks, have you been bothered by feeling worried, tense or anxious…
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Preventing type 2 diabetes

The big new thing in here is stating for, I think, the first time in NICE guidance, that Type 2 Diabetes can be diagnosed from 2 HbA1C > 6.5% (48), as well as the traditional methods. The rest is based on previous or existing guidance about dietary advice / assessing barriers to change etc, so…
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Rhesus D prophylaxis in pregnancy

This guideline is very relevant to us. Nothing has really changed, but it reiterates best practice. It applies to non-sensitised women (ie who don’t have anti-D antibodies on their booking bloods): When would we need to give it? Most of the time (eg terminations / evacuation of products etc), anti-D will be given in secondary…
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RCOG | Breast cancer and pregnancy

A lot of this is aimed at specialists. There are some useful bits about preconception counselling in a woman who’s had breast cancer and also advice about breast feeding. The most useful things are: New presentation of breast lump – ensure you refer women as you would if they weren’t pregnant. Women can have treatment…
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Nice | Ovarian cancer

This is well worth a read – it changes our way of investigating women with abdominal symptoms quite a lot. Using our current system, most women are diagnosed at a late stage, so we need to do something different. The basis of this guideline is: 1) Identify women Women over 50 who have had symptoms…
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Nice | Tuberculosis

This is quite a complex, meaty guideline, with lots of flow-charts. Remember to consider if a newly registering patient should be screened and remember BCG in neonates at risk, but otherwise I would suggest referring to the guideline if a specific situation arises. However, the main new things here are: At registration of a new…
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Sign | Management of testicular germ cell tumours

Most of this is not new for us, or is for secondary care. Worthwhile noting is: 2 week wait refer if epididymo-orchitis/orchitis is suspected but is not resolving in 2 to 3 weeks. Patients have an increased risk of cardiovascular disease, because of chemo and radiotherapy, so ensure that they are given appropriate lifestyle advice.…
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Inflammatory Bowel Disease

This is a guideline which seems to be aimed predominantly at specialists. From our point of view there are a few useful bits: Patient Information. It lists some useful sources of information for patients. Faecal calcoprotein can be used in the assessment. (There is a good editorial on this in the BMJ. It has a…
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