Guidelines

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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Alzheimer’s drugs

Some new alzheimers drugs Donepazine, galantamine and rivastigmine can now be used in mild, as well as in moderate disease. Memantine can be used if someone is intolerant to or has contraindications to the other drugs and can also be used in severe disease. Initiation is still by specialists but follow-up can be done by…
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Vulval Skin Disorders

This is a good guideline to have a quick read through as it is a good summary of vulval skin disorders. There is a really useful patient hand out on vulval skin care on page 17. Ask the obvious questions and also about sexual problems, cervical cytology history, immune deficiency, any pads or tampons or…
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Reduced Fetal Movements

A lot of this is what we already do. However there is a good flow chart at page 14. New things for me were: In a pregnancy with 2 or more episodes of reduced fetal movements (RFM), there is a worse outcome, so warn the mother to get checked each time. If a woman hasn’t…
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Food Allergy in Children

This guideline is really quite complex. Unfortunately it basically says that if you or the parents suspect food allergy, test for that food. It gives IgE (immediate) and non IgE mediated (delayed) associated symptoms. For an IgE mediated reaction, a skin-prick test or IgE blood test should be used (aimed at the suspected target, rather…
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Maternal collapse

There is a good algorithm that you can print out on page 22. Remember that in BLS for a pregnant woman, you need a tilt to the left of 15°. This can be achieved by getting someone to put their knees under her right side. Remember that after 20/40, perimortem fetal delivery can save the…
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Anaemia in CKD

Most of this is aimed a specialists, though some of it is useful to know: If GFR ≥ 60, anaemia is unlikely to be due to CKD. In adults you would want to investigate anaemia due to CKD further when their Hb < 11, or if they have symptoms of anaemia.     Louise HudmanI’m…
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BASHH | Pelvic inflammatory disease

Little of this new guideline is new. Take home messages for me were: Only 25% cases are caused by gonorrhoea/chlamydia. The rest are other STDs and non STDs. Any young, sexually active female (ie <25 yrs) should have PID considered and empiric treatment offered if they present with recent onset bilateral lower abdominal pain and…
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Alcohol use disorder (part 2)

A lot of this alcohol use disorder guideline is aimed at specialists. Basically, anyone with dependence (AUDIT > 15) needs specialist referral. Under 18s should be referred to CAMHS. There are specific tools which are listed for use with under 16s instead of the AUDIT screen. If someone has harmful drinking, but isn’t dependent, a ‘brief intervention’…
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BASHH | Chlamydia testing

Most of the information is these guidelines is stuff we know. Learning points for me were: Endocervical swabs and HVS swabs have a similar sensitivity (before, the advice was that endocervical swabs were essential for testing where there are symptoms). FCU is not as sensitive in women. To take an HVS, you should rotate the…
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Skin cancer prevention

This new guidance really covers common sense stuff about sun-protection whilst also encouraging patients to balance that with the need for sun-exposure to get adequate Vit D     Louise HudmanI’m a salaried GP in Hampshire. NEW! – Use the NASGP CPD templates to record your reflections.
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