Clinical Update

In this episode, Dr Prina Ruparelia, joint clinical director for respiratory medicine at St Bartholomew’s and Royal London Hospitals, talks to Dawn Liz Powell about identifying and managing chronic cough in primary care.

Dr Ruparelia explains that after ‘worrying conditions’, such as lung cancer, have been excluded in patients with chronic cough, a thorough history should be taken to identify any potentially ‘treatable traits’. Treatable traits, she says, are factors (for example, smoking) that might cause a cough. Once identified, these traits can be addressed to help manage the cough.

One trait, in particular, discussed in this episode is cough hypersensitivity. Dr Ruparelia explains that this is ‘under-recognised’ and probably relates to a dysregulation of the neuronal pathways that control cough — resulting in a cough response to relatively minor irritants,such as perfume or laughing. 

You can access the website version of this podcast on MIMS Learning to make notes for your appraisal. MIMS Learning offers hundreds of hours of CPD for healthcare professionals, along with a handy CPD organiser.

This podcast is presented by medical editors and discusses educational content written or presented by doctors, nurses and other healthcare professionals on the MIMS Learning website and at live events.

MIMS Learning modules 

Persistent cough - red flag symptoms

Management of chronic cough in children

Presentation and management of chronic ventilatory failure

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Are you aware of the recommended steps in managing anaphylaxis on your surgery premises? When could back pain be an emergency? Find out with this episode of the Clinical Update podcast, discussing just a few of the potential emergencies that you could encounter as a GP.

After listening to this podcast, healthcare professionals should be better able to:

• Reflect on management of epistaxis
• Recall the current recommendations from the Resuscitation Council UK on the management of anaphylaxis
• Identify when back pain should be treated as an emergency
• Recall key considerations around supply of emergency contraception

You can access the website version of this podcast on MIMS Learning to make notes for your appraisal. MIMS Learning offers hundreds of hours of CPD for healthcare professionals, along with a handy CPD organiser.

Please note: this podcast is presented by medical editors and discusses educational content written or presented by doctors, nurses and other healthcare professionals on the MIMS Learning website and at live events.

Useful links

Resources from MIMS Learning

Choices in emergency contraception

Acute low back pain: initial presentation to primary care

Guidance update: anaphylaxis

Chest pain - red flag symptoms

Epistaxis - red flag symptoms

External resources

NHS. Chest pain. August 2023.

BSACI. Adrenaline auto-injector prescription for patients at risk of anaphylaxis: BSACI guidance for primary care. June 2023.

BASS. Cauda equina syndrome. Accessed November 2024.

Champions Charity. Cauda equina syndrome red flags. Accessed November 2024.

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Grief is a universal human experience, and the support people receive in the aftermath of a bereavement can have ongoing implications for their health and wellbeing. Linda Magistris, CEO and Founder of The Good Grief Trust, talks to MIMS Learning deputy editor Rhiannon Ashman about effective signposting for bereaved people, appropriate language around death, peer-to-peer support for healthcare professionals, and the popularity of ‘grief cafes’.  

After listening to this podcast, healthcare professionals should be more able to:

• Recall how to effectively signpost people who have been bereaved to support and up-to-date information
• Use appropriate and thoughtful language around death and bereavement
• Understand the implications on people’s mental and physical health of not receiving the right support at the right time
• Help to normalise feelings of grief for those who have been bereaved
• Know where to access peer support around grief and bereavement

You can access the website version of this podcast on MIMS Learning to make notes for your appraisal. MIMS Learning offers hundreds of hours of CPD for healthcare professionals, along with a handy CPD organiser.

Please note: this podcast is presented by medical editors and discusses educational content written or presented by doctors, nurses and other healthcare professionals on the MIMS Learning website and at live events.

Useful links

Resources from MIMS Learning

End of life care: a guide for GPs and nurses

Managing diabetes in people nearing the end of life

Managing respiratory problems in palliative care

End of life care in children

External resources

The Good Grief Trust

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In this episode of the MIMS Learning podcast, the MIMS Learning editors look at the diagnosis and management of chronic obstructive pulmonary disease (COPD) in primary care. 

They explore why the Global Initiative for Chronic Obstructive Lung Disease (GOLD) has changed its definition of COPD in recent years and why this is important. They also look at the risk factors for COPD, how it is diagnosed, management options, and identifying and treating exacerbations.

After listening to this podcast, healthcare professionals should be more able to:

• Discuss the mortality and morbidity associated with COPD
• Review the risk factors for COPD, including alpha-1 antitrypsin deficiency
• State which tests are used for identifying airflow obstruction
• Understand management strategies, including dual and triple therapies
• Appreciate the need to identify and treat exacerbations

You can access the website version of this podcast on MIMS Learning to make notes for your appraisal. MIMS Learning offers hundreds of hours of CPD for healthcare professionals, along with a handy CPD organiser.

Please note: this podcast is presented by medical editors and discusses educational content written or presented by doctors, nurses and other healthcare professionals on the MIMS Learning website and at live events.

Resources from MIMS Learning

Guidance update: global strategy for prevention, diagnosis and management of COPD

COPD pathology and diagnosis

COPD monitoring and exacerbations

COPD management and comorbidities

COPD and mental wellbeing

Pulmonary rehabilitation for people with breathlessness

Interstitial lung disease: clinical review

The role of integrated care in the management of COPD

Inhaler prescribing for better outcomes

MIMS Learning

Register for a free healthcare professional account

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Prostate cancer is common: one in four Black men will develop it, and one in eight white men. Professor Mike Kirby talks to MIMS Learning editor Pat Anderson about how GPs should approach diagnosis, and provides tips on best care for people who are undergoing or have undergone prostate cancer treatment. He says GPs have a vital role to play in managing cardiovascular risk and managing treatment-related problems.

After listening to this podcast, healthcare professionals should be more able to:

• Identify symptoms associated with prostate cancer
• Appreciate why symptoms alone do not paint the whole picture
• Understand the role of PSA testing for prostate cancer
• Understand what investigations patients with suspected prostate cancer will be offered
• Reflect on the advantages and disadvantages of different treatment options 
• Manage cardiovascular risk and treatment-related problems in men who have had treatment

You can access the website version of this podcast on MIMS Learning to make notes for your appraisal. MIMS Learning offers hundreds of hours of CPD for healthcare professionals, along with a handy CPD organiser.

Please note: this podcast is presented by medical editors and discusses educational content written or presented by doctors, nurses and other healthcare professionals on the MIMS Learning website and at live events.

Useful links

Resources from MIMS Learning

Guidance update: NICE guidelines on prostate cancer

Managing complications of treatments for prostate cancer

Benign prostatic hyperplasia: clinical review

Charities

Prostate Cancer Research

Prostate Cancer UK

The Errol McKellar Foundation

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Skin, hair and nail symptoms that may indicate a systemic illness are the focus of this episode of the podcast, including pruritus, skin pigmentation, and hair loss. We also discuss how oral symptoms can act as a marker of deteriorating glycaemic control in patients with diabetes, the link between inflammatory skin conditions and cardiovascular risk, and some cutaneous manifestations of psychological distress.

After listening to this podcast, healthcare professionals should be more able to:

• Spot serious conditions that might present with pruritus
• Recall the common culprits for drug-induced skin reactions
• Identify potential underlying systemic causes of erythema
• Describe the oral signs and symptoms that can indicate malignancy or autoimmune disorders
• Consider skin, hair and oral manifestations of psychological distress

You can access the website version of this podcast on MIMS Learning to make notes for your appraisal. MIMS Learning offers hundreds of hours of CPD for healthcare professionals, along with a handy CPD organiser.

Please note: this podcast is presented by medical editors and discusses educational content written or presented by doctors, nurses and other healthcare professionals on the MIMS Learning website and at live events.

Useful links

Resources from MIMS Learning

Case study: pruritus

Skin problems in haematological disease

Erythema - red flag symptoms

Skin problems in transgender people

The identification and management of diabetes-related foot complications

Oral signs and symptoms of systemic disease

Smoking, alcohol and psoriasis

Psoriasis in primary care: clinical review

Extra-intestinal manifestations in IBD

A case of acne excoriée with multiple psychosocial comorbidities

A case of delusional infestation and coexisting psoriasis

MIMS Learning

Register for a free healthcare professional account

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Frailty is a state akin to walking on a tightrope - a relatively small `wobble’ can have significant consequences. In an interview with MIMS Learning editor Pat Anderson, frailty GP Dr Alistair Robertson explains the concept of frailty and how it can be usefully applied in general practice.

After listening to this podcast, healthcare professionals should be more aware of:

• The definition of frailty
• The benefits of identifying and managing frailty
• How to identify frail patients in your practice
• How to involve colleagues
• Services that can help you to manage frailty
• Professional development around frailty

You can access the website version of this podcast on MIMS Learning to make notes for your appraisal. MIMS Learning offers hundreds of hours of CPD for healthcare professionals, along with a handy CPD organiser.

Please note: this podcast is presented by medical editors and discusses educational content written or presented by doctors, nurses and other healthcare professionals on the MIMS Learning website and at live events.

Useful links

MIMS Learning resources

Frailty: clinical review

Podcast: breathlessness, diabetes and frailty, and measles

Diabetes and older people

External resources

RCGP. How to develop and maintain a role in frailty. August 2023.

RCGP. The GP+ Careers podcast. 3: GP+ Frailty with Dr Alistair Robertson. [Spotify] September 2024.

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Though women often experience sexual health difficulties, few seek medical help for these difficulties. In this studio discussion, the MIMS Learning editors review the potential reasons for this under-reporting, and they also discuss the various ways in which GPs can improve consultations for sexual health issues. The editors also talk about some commonly encountered conditions, like vulvodynia, chlamydia and dyspareunia. 

After listening to this podcast, healthcare professionals should be more aware of:

• How to conduct initial consultations in women with psychosexual disorders
• The different types of vulval pain and their treatment options
• Red flags for patients presenting with dyspareunia
• Clinical features of and treatment for chlamydia

You can access the website version of this podcast on MIMS Learning to make notes for your appraisal. MIMS Learning offers hundreds of hours of CPD for healthcare professionals, along with a handy CPD organiser.

Please note: this podcast is presented by medical editors and discusses educational content written or presented by doctors, nurses and other healthcare professionals on the MIMS Learning website and at live events.

Useful links

MIMS Learning resources

Psychosexual disorders in women

Benign vulval conditions

Dyspareunia in women - red flag symptoms

Amenorrhoea - red flag symptoms

Heavy menstrual bleeding - red flag symptoms

Equity in maternity care - Lessons from MBRRACE

External resources

NICE. Child abuse and neglect. NG76. October 2017.

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In this episode, GP Professor Lesley Kavi (chairperson of the charity PoTS UK) talks to Dawn Liz Powell about diagnosing and managing postural tachycardia syndrome (PoTS) in primary care. Professor Kavi explains that PoTS refers to an abnormal response to an upright posture — defined as a persistent increase in heart rate of more than 30 beats per minute (40 beats per minute in children) upon standing. 

While the exact aetiology of PoTS is not known, it can occur after a virus (such as COVID) and is strongly associated with joint hypermobility syndrome. 

The condition can cause a range of symptoms, including (but not limited to) fatigue, dizziness, syncope, and brain fog. This can make diagnosis difficult, with Professor Kavi noting that many people with PoTS attend several medical appointments without getting a clear diagnosis or are categorised as having ‘medically unexplained symptoms’. 

You can access the website version of this podcast on MIMS Learning to make notes for your appraisal. MIMS Learning offers hundreds of hours of CPD for healthcare professionals, along with a handy CPD organiser.

Please note:

• This podcast is intended for healthcare professionals. If you are a person with PoTS, or suspect you have PoTS, the information in this episode should not be seen as a replacement for medical advice from a trained professional. Please consult with your doctor before making any changes to your lifestyle and/or to any medications you may be taking. 
• This podcast is presented by medical editors and discusses educational content written or presented by doctors, nurses and other healthcare professionals on the MIMS Learning website and at live events.
• In this interview, Professor Kavi refers to ‘CFS/ME’. However, the term is now ‘ME/CFS’. 

MIMS Learning modules 

Diagnosis and management of functional seizures

Guidance update: latest NICE guidelines on neurological conditions

Guidance update: NICE guidance on myalgic encephalomyelitis/chronic fatigue syndrome

Register for a free healthcare professional account 

https://www.mimslearning.co.uk/register

PoTS UK 

Managing PoTS

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GPs commonly see patients who are experiencing hearing loss, ear pain or inflammation, or who can hear sounds with no external cause (tinnitus). In this episode the MIMS learning editors focus on how to eliminate red flags, how to address causes of hearing loss, manage acute otitis externa, and support patients with tinnitus.

After listening to this podcast, healthcare professionals should be more aware of:

• How hearing loss is linked to the risk of dementia
• The Brighton grading scheme for classifying acute otitis externa, and how it is treated
• Signs and symptoms of necrotising otitis externa
• Red flag symptoms in hearing loss
• Presentations of tinnitus, and what it can sound like
• Management options for tinnitus

You can access the website version of this podcast on MIMS Learning to make notes for your appraisal. MIMS Learning offers hundreds of hours of CPD for healthcare professionals, along with a handy CPD organiser.

Further support for people with tinnitus can be found from the Tinnitus UK online chat or helpline on 0800 018 0527.

Please note: this podcast is presented by medical editors and discusses educational content written or presented by doctors, nurses and other healthcare professionals on the MIMS Learning website and at live events.

Useful links

Resources from MIMS Learning

Primary care research briefing July 2024 

Otitis externa clinical review

ENT emergencies

Hearing loss - red flag symptoms

Tinnitus - red flag symptoms

MIMS Learning

Register for a free healthcare professional account

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