Primary Care Knowledge Boost

Doctors Lisa and Sara talk to Respiratory Physiotherapist Thomas James about COPD. We start with what COPD is, when to suspect it, a standard work up, pitfalls and points of consideration about spirometry, before moving on to an overview of management. We then cover some changes in the way COPD exacerbations are managed in South Manchester and the role of Eosinophils in both acute and chronic management. Understanding the role of Pulmonary rehabilitation, prednisolone and exercise in management are particular highlights. We cover our learning points from the episode at the end.  You can use these podcasts as part of your CPD - we don’t do certificates but they still count :) Useful resources:  NICE COPD in adults (last updated Sept 2023): https://www.nice.org.uk/guidance/QS10 The Global Initiative for Chronic Obstructive Lung Disease (GOLD) Spirometry Guide: https://goldcopd.org/gold-spirometry-guide/ Association for Respiratory Technology and Physiology (ARTP) advice on Spirometry Interpretation: https://www.artp.org.uk/en/spirometry Greater Manchester Medicines Management Group (GMMMG) COPD Management Plan Guideline (2021): https://gmmmg.nhs.uk/wp-content/uploads/2021/11/COPD-Treatment-Guideline-Nov-2021-V7.1.pdf Greater Manchester Medicines Management Group (GMMMG) COPD Inhaler Guide (2021): https://gmmmg.nhs.uk/wp-content/uploads/2023/05/GMMMG-COPD-Inhaler-Guide-update-Mar-2023.pdf Greater Manchester CURE Project for Smoking Cessation: https://gmcancer.org.uk/programmes-of-work/treatment/the-cure-project/ Greater Manchester Change, Grow, Live Services including Smoking Cessation: https://www.changegrowlive.org/ Primary Care Respiratory Society MRC Breathlessness scale: https://www.pcrs-uk.org/mrc-dyspnoea-scale Our podcast with Dr Lesley Henson and Dr Caitriona MacDermott on Breathlessness in Palliative Care (May 2024): https://pckb.org/e/breathlessness-in-palliative-care/ ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our quick anonymous survey here: https://pckb.org/feedback Email us at: [email protected] ___ This podcast has been made with the support of GP Excellence and Greater Manchester Integrated Care Board. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Doctors Lisa and Sara talk to Dr Joanna Bircher, Dr Nikesh Vallabh, Shelley Ryder (SWAN PCN Manager and Transformation Lead) and Dr Fran Fitton. We find out what proactive care is all about and then launch into example projects around dementia care that Shelley and Fran are involved in. We hope this gives people a flavour of what proactive care projects could entail in General Practice in terms of design and implementation.  Later in the year, we hope to bring more examples of projects and how they managed to get them off the ground.  You can use these podcasts as part of your CPD - we don’t do certificates but they still count :) Useful resources:  NHS Long Term Plan, Overview and Summary: https://www.longtermplan.nhs.uk/online-version/overview-and-summary/ Proactive care: New GM support offer for 20 PCNs: https://gmpcb.org.uk/proactive-care-new-gm-support-offer-for-20-pcns/ An Introduction to Quality Improvement: https://www.podbean.com/ew/pb-ubnht-114762e ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our quick anonymous survey here: https://pckb.org/feedback Email us at: [email protected] ___ This podcast has been made with the support of GP Excellence and Greater Manchester Integrated Care Board. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

***SUMMER REWIND  - INITIALLY RELEASED ON 31ST JAN 2024*** To get in touch: [email protected] Doctors Lisa and Sara talk to Senior Pharmacist Sarah Hafeez about Polypharmacy. She explains the difference between inappropriate and appropriate polypharmacy before talking through some typical cases that illustrate several examples of common scenarios.  This leads to discussions on prioritising concerns, weaning/stopping medications, counselling patients on the effects of Opioids and Gabapentinoids and involving community teams aiming for successful reductions of addiction forming medications. Other gems include a discussion of the potential long term risks of Proton Pump Inhibitors and advice on weaning, remembering to consider anticholinergic burdens as well as handy resources for tackling Polypharmacy, Structured Medications Reviews and medication reductions. You can use these podcasts as part of your CPD - we don’t do certificates but they still count :) Useful resources:  Greater Manchester Medicines Management Group: Inappropriate Polypharmacy Review and Treatment Optimisation: Resource Pack (from Dec 2022, accessed Dec 2023): https://gmmmg.nhs.uk/wp-content/uploads/2023/02/GMMMG-Polypharmacy-resource-pack-v3.0.pdf Scotland Polypharmacy Resources for Professionals and for Patients: https://www.polypharmacy.scot.nhs.uk/for-patients-and-carers/ Scottish Polypharmacy Guidance 2018: https://www.therapeutics.scot.nhs.uk/wp-content/uploads/2018/04/Polypharmacy-Guidance-2018.pdf Lewis T. Using the NO TEARS tool for medication review. BMJ. 2004 Aug 21;329(7463):434. doi: 10.1136/bmj.329.7463.434. PMID: 15321901; PMCID: PMC514207 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC514207/ Toolkit for General Practice in Supporting Older People Living with Frailty (includes a great Appendix of the STOPP/START criteria (2017): https://www.england.nhs.uk/wp-content/uploads/2017/03/toolkit-general-practice-frailty-1.pdf An example of an Anticholinergic Burdon Resource from West Essex CCG 2020: https://westessexccg.nhs.uk/your-health/medicines-optimisation-and-pharmacy/clinical-guidelines-and-prescribing-formularies/04-central-nervous-system/61-anticholinergic-side-effects-and-prescribing-guidance/file Canadian Resource for Deprescribing including reducing medications and some patient information leaflets: https://deprescribing.org/ Resource for help reducing and stopping medications: https://medstopper.com/ Me and My Medicines Resource for Patients to look through their medications before reviews or for information: https://meandmymedicines.org.uk/ Anticholinergic Medications and Risks of Dementia Cochrane Editorial with Reports in Link (Sept 2021): https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.ED000154/full Anticholinergic drugs and risk of dementia: Time for action? British Pharmacological Society. Bell B et al Jun 2021 (9:3). Accessed 15/1/2024:  https://bpspubs.onlinelibrary.wiley.com/doi/full/10.1002/prp2.793 Cognitive Effects of Anticholinergic Load in Women with Overactive Bladder. Clin Interv Aging. 2020; 15: 1493–1503: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7457731/ Greater Manchester Medicines Management Group: Management of Overactive Bladder Including a simple Bladder Diary before and after stopping Medications (Jun 2019): https://gmmmg.nhs.uk/wp-content/uploads/2021/08/Management-of-OAB-in-adults-v3-0-approved-Aug-2019.pdf ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our quick anonymous survey here: https://pckb.org/feedback Email us at: [email protected] ___ This podcast has been made with the support of GP Excellence and Greater Manchester Integrated Care Board. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Doctors Lisa and Sara talk to Palliative Care Consultant Lesley Henson and Specialty Doctor Caitriona MacDermott for a discussion on common issues Primary Care Clinicians face when dealing with patients at the end of life and their families. We discuss Hospice admission criteria and the role of the hospice. We then look at how they approach questions around palliative symptoms like breathlessness, reduced oral intake and this leads on to a conversation about assessing and discussing options around hydration. We get their approach to answering questions around prognosis and navigating the scenario where relatives/carers might see the set of symptoms differently to other carers.  Useful resources:  Hospice UK: What is Hospice Care: https://www.hospiceuk.org/information-and-support/your-guide-hospice-and-end-life-care/im-looking-hospice-care/what-hospice Greater Manchester Palliative Care Symptom Control Guidelines for Adults (2019): https://www.england.nhs.uk/north-west/wp-content/uploads/sites/48/2020/01/Palliative-Care-Pain-and-Symptom-Control-Guidelines.pdf Clinical Knowledge Summaries: Palliative Care General Issues: https://cks.nice.org.uk/topics/palliative-care-general-issues/ Pain Assessment Tool for People with Dementia or Communication Difficulties from Doncaster and Bassetlaw NHS Hospitals (2015): https://www.dbth.nhs.uk/wp-content/uploads/2018/10/DBH-Pain-Tool.pdf MacMillan Resources: Managing Breathlessness, advice for Patients: https://www.macmillan.org.uk/cancer-information-and-support/impacts-of-cancer/breathlessness/managing-everyday-life-with-breathlessness?gad_source=1&gclid=cjwkcajwrckxbhbmeiwaivf8rhfcgjkvqpsq-is9gahloaxjoyq9tsfxwykwym08ewcsyoluupn-1xocq1sqavd_bwe&gclsrc=aw.ds Cancer Research UK Resource for Patients and relatives around Breathing Problems for Patients with Cancer: https://www.cancerresearchuk.org/about-cancer/coping/physically/breathing-problems _____ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our quick anonymous survey here: https://pckb.org/feedback Email us at: [email protected] _____ This podcast has been made with the support of GP Excellence and Greater Manchester Integrated Care Board. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.