Are you up to date on the new FSRH Obesity guideline?
Nadine is a 25 year old woman and has been using depot medroxyprogesterone acetate (DMPA) as contraception for the past year. She has come in for review as would like to continue with this. She has no past medical history of note. She has a BMI of 38. She smokes 20 cigarettes a day and has been given smoking cessation advice but has no plans to give up.
A high BMI on its own does not restrict the use of DMPA, but what about in combination with smoking? Does this change things?
In May 2019 the FSRH published new guidance on the provision of contraception to women who are overweight and women with obesity. Our ask an expert module on Contraception in primary care has been updated with a new question to summarise what this guideline update means for your practice.
"The best module I have taken in a long time. Very good."
“Really great and concise article. Good update"
How confident do you feel managing surgical site infections in primary care?
At least 5% of operations carried out in secondary care are complicated by surgical site infection.
Minor surgical site infections can be difficult to diagnose, as there is no single validated diagnostic tool. It is not always easy to distinguish between infection and the inflammatory process involved in normal healing, due to an overlap of symptoms and signs including heat, redness, swelling, and pain. Because of this, clinicians may use antibiotics inappropriately, adding to the risk of antibiotic resistance.
Our module Surgical site infection: a primary care focus on prevention and management covers both prevention and treatment of surgical site infections, and will help you to feel more confident answering patients’ questions about postoperative wounds.
"Very good empirical advice here and evidence based throughout"
"Really helpful sensible clear guidance"
New module on chronic rhinosinusitis
A 45 year old woman attends your morning surgery. She has had a “stuffy” nose for the last six months. She says she often feels like she has to clear her throat, and she also has clear nasal discharge. On anterior rhinoscopy, her nasal mucosa looks pale and there is hypertrophy of the turbinates. The rest of her examination is normal. There is nothing of note in her past medical history. You make a clinical diagnosis of chronic rhinosinusitis.
What should you do next?
Check your answer in our new module: Step by step: How to diagnose and manage patients with chronic rhinosinusitis in primary care, which covers how to distinguish chronic rhinosinusitis from other similar conditions, what treatment to start in primary care, and when to refer to a specialist.
How can you improve outcomes for patients with frailty?
You see an 85 year old man who is moderately frail and partially sighted. You are trying to establish a care and support plan (CSP) in partnership with your patient. His main goal is to remain able to go to the park with his dog.
His main concerns are that his mobility is limited by his arthritis and he has lost his ability to drive because of his poor vision. On good days he is able to use a stick to walk slowly to the park with his dog, but there are also bad days that he has to spend at home.
How would you work with him to help him achieve his goal?
Check your answer in our new clinical pointers module on frailty which includes practical videos to help you to assess and objectively measure frailty, plan the care of older people who are frail to improve their outcomes, and prevent progression of frailty.
"A really useful and practical approach to assessment and care and support planning"
New clinical pointers module on faltering growth
Paul is 3 months old and was born four weeks early with mild respiratory distress. He was discharged after a short stay in special care. His mother has had difficulty breastfeeding, so is giving him expressed breast milk. He taking 3 ounces of expressed milk every two to three hours during the day and sleeps for six hours at night, managing about 22 ounces in 24 hours. His health visitor shows you his growth chart as she is concerned his weight gain has crossed the centile lines. He currently only weighs 4.5 kg, having been born at 2.2 kg on the 9th centile. He frequently has small milky vomits. He seems otherwise well.
What should you advise?
Check your answer in our new moduleclinical pointers: faltering growth. In this module, Dr Nicola Pritchard provides some insight into practical primary care issues for GPs when assessing children for faltering growth, including advice on when you should be concerned, and when you can be reassuring.
"Excellent and practical!!"
Updated module on bulimia nervosa
A 23 year old man, Iqbal, presents to your practice with dizziness. On questioning you find out that he exercises for two to three hours each day at the gym. You wonder whether he may have an eating disorder.
To screen for a possible diagnosis of bulimia nervosa, what kind of initial questions would it be appropriate to ask?
Check your answer in our updated clinical pointers module: Bulimia nervosa in primary care.
Patients may not present in primary care directly with concerns that they have an eating disorder so it is important to look out for this in consultations. This practical module offers a guide to recognising bulimia nervosa in primary care, as well as to the diagnosis and initial management of potential complications, and available treatments.
"Excellent distillation of essential information."
Are you ready for hay fever season?
David is a 16 year old student who is taking an intranasal corticosteroid spray plus an intranasal antihistamine for hay fever. He is remembering to take both regularly, and he uses the sprays correctly. However, he still has troublesome symptoms and he is worried about some important exams in a month’s time.
Would oral steroids be an appropriate option?
Check your answer in our Ask an expert: Hay fever and perennial allergic rhinitis module. This module offers expert answers to GPs’ questions about hay fever, including how to treat patients using a stepwise approach, different treatment options, and when to refer your patients.
"Excellent module. Sound advice here. with very good tips on step up treatment. Will use this information in my patients - highly recommended "
Do you feel confident approaching end of life care decisions in patients with non-malignant disease?
Patients with end-stage non-malignant disease may not receive the same level of palliative care compared with patients with cancer, even though they often experience similar distressing symptoms.
Our new module, Clinical pointers: Palliative care in non-malignant disease, provides evidence based, practical tips to help improve your approach to palliative care in these patients.
The module includes advice on the management of end of life symptoms in heart failure, COPD, renal failure, Parkinson’s disease, motor neurone disease, multiple sclerosis, and dementia.
"Fantastic module with so much very useful and practical info, I was so impressed with this one. End of life care in non cancerous diseases is clearly an increasing area of primary care.”
New module on managing type 2 diabetes in primary care
A 54 year old man, who was diagnosed with type 2 diabetes three years ago, attends your clinic for his annual review. He works as an electrician and is white Caucasian. His BMI is 32 kg/m2. Apart from his diabetes, he has no significant medical history. He accepts that he is a little overweight, but he enjoys hiking with his wife when they have the time.
His blood pressure at this visit is 138/76 mmHg. His lipids are within healthy limits. He takes metformin 2 g per day and gliclazide 320 mg per day. His HbA1c has risen by one per cent from a year ago to a current value of 66 mmol/mol (8.2%).
What would be an appropriate next step in his management?
Check your answer in our new module: Managing type 2 diabetes in primary care. Using case scenarios it will guide you through the management of type 2 diabetes, providing clear advice on treatment thresholds and how to step up medications.
Managing dementia in primary care
You are asked to see Mrs Lane during your weekly visit to a care home. She is 78 years old, has mild dementia, and has been a resident in the care home for almost a year. Over the past few weeks she has started wandering into other people’s rooms and taking their things. This is now causing distress to both Mrs Lane and the other residents. The care assistants have not noticed any cause for this change in her behaviour.
Would medications be useful here? What kind of non drug measures could you consider?
Check your answer in our recently updated module: Management of dementia in primary care, which includes videos and relevant case scenarios to help you in the management of your patients with dementia.
"Helpful module with some very good pointers especially in terms of medication used in patients with dementia who have depression or psychotic symptoms."