Recent Posts by Louise Hudman

Low back pain and sciatica

This is an updated guideline from NICE on the management of low back pain and sciatica. There is quite a bit that is new in this guideline, but it probably doesn't really add much to our current management. The biggest change is that they don't advise the use of paracetamol on its own. Risk stratify…
Read more

Hormonal contraception and depression

You may have seen recent news reports regarding a link between depression and the use of hormonal contraception. The FSRH have released a useful statement outlining their opinion of the link between depression and the use of hormonal contraception. Basically a recent observational study from Denmark suggested an association between the use of any hormonal…
Read more

Investigation and management of eosinophilia

This is a new guideline from the British Society of Haematology on the investigation and management of patients with eosinophilia. This gives a really nice, simple clear outline on how to investigate patients, as well as a lot of more complex advice aimed at specialists. I have tried to distill the bits that are useful…
Read more

CRP testing in general practice

Two new 'MIBs' have been released by NICE. MIBs are 'Medtech Innovation Briefings'. They make no assessment of cost-effectiveness, nor whether a technology should be used, but just describe that a technology is available and what it is. These two MIBs, look at two different methods of testing for CRP in general practice. One method…
Read more

New asthma guidelines from BTS and Sign

This is an update on the asthma guideline from BTS / SIGN. There are lots of little changes, but probably the biggest change is that they seem to have moved away from using short-acting b2 agonists in the initial management. The first step in children is now very low dose inhaled steroids and in adults…
Read more

Degarelix for treating advanced prostate cancer

This is a new guideline from NICE advising that degarelix can be used in the treatment of hormone-dependent advanced prostate cancer. When can it be used? In people with spinal metastases. How is it different from other treatments? Degarelix is a selective gonadotrophin-releasing hormone antagonist. It reduces gonadotrophin release from the pituitary and hence testosterone…
Read more

Ataluren for treating Duchenne Muscular Dystrophy

This is a new guideline from NICE recommending that ataluren can be used for treating some people with Duchenne Muscular Dystrophy if: The disease is the result of a 'nonsense mutation' AND The patient is over 5 years old AND They are still able to walk. Why is this so significant? Basically ataluren restores the…
Read more

Ulipristal acetate for the treatment of fibroids

This is an update to the 2007 NICE guideline on managing heavy menstrual bleeding. It advises that ulipristal acetate can be used in the treatment of fibroids. Specifically: Offer ulipristal acetate 5mg for up to 4 courses to a woman with heavy menstrual bleeding, fibroids of 3cm or more in diameter and Hb of 102g/L…
Read more

Familial hypercholesterolaemia and ezetimibe

This is an update to the NICE guideline from 2008 on managing familial hypercholesterolaemia. Basically ezetimibe is now recommended as monotherapy in treatment if: patients can not tolerate statin therapy. statin therapy is contra-indicated. Ezetimibe can be use as add-on therapy to statins if: total cholesterol or LDL cholesterol is not controlled by appropriate statin…
Read more

RCOG | Ovarian cysts in postmenopausal women

This is an updated guideline from RCOG on investigating and managing ovarian cysts in post-menopausal women. I have previously summarised a guideline from NICE on ovarian cancer and from the RCOG on managing cysts in premenopausal women. As both these came out some time ago, I will do a general overview, as I'd forgotten quite…
Read more

Nausea and vomiting in pregnancy – the PUQE score

This is a new guideline from the RCOG on the management of nausea and vomiting in pregnancy. Most of this isn't going to change our practice, but if (like me) you get nervous about prescribing antiemetics in pregnancy, it gives good guidance. I'm just summarising things that were new to me, or that I felt…
Read more

Nice | Who should we be testing for cirrhosis?

This is a new guideline from NICE on cirrhosis. The most important bit for us is knowing who should be tested as we may need to be referring these patients on. Higher risk patients Hepatitis B Hepatitis C Misuse of alcohol BMI of 30 or more Type 2 diabetes Who should be tested for cirrhosis?…
Read more

Belimumab for treating SLE

This is a new guideline from NICE on using Belimumab for SLE. I am mentioning this guideline because I hadn't appreciated that biologics could be used in the treatment of SLE. It will be an option as add-on treatment, but will only be appropriate in certain cases (as defined in the guideline).
Read more

Nice | Non-alcoholic fatty liver disease NAFLD

This is a new guideline from NICE on non alcoholic fatty liver disease (NAFLD) in children, young people and adults. To be honest, I don't think this guideline is terribly helpful. I've done a brief summary, then more detailed notes. In summary: Adults There is no advice on who to test to diagnose NAFLD, nor…
Read more

Nice | Detection and management of sepsis

This is a new guideline from NICE on the detection and management of sepsis. None of this is likely to be new, but it is worth looking through. I think the main reason is, sadly, from a medico-legal point of view. I guess if we have not documented obs that have been clearly laid out,…
Read more

Evolocumab and Alirocumab for treating dyslipidaemia

There are two new guidelines from NICE on the use of Evolocumab and Alirocumab for treating primary hypercholesterolaemia (both familial and non-familial) and mixed dyslipidaemia. What are these drugs? Both Evolocumab and Alirocumab are monoclonal antibodies that inhibit an enzyme that down-regulates LDL receptors. This therefore increases the number of LDL receptors and so increases…
Read more

Nice | Alzheimer’s drugs

This is a guideline update from NICE on the use of  donepezil, galantamine, rivastigmine and memantine in Alzheimer's disease. Donepezil, galantamine and rivastigmine (the acetylcholinesterase - AChE - inhibitors) can now be used in mild disease, as well as in moderate disease. These drugs all work by increasing the level of ACh at sites of…
Read more

Sacubitril valsartan for chronic heart failure

This is a new guideline from NICE on when sacubitril valsartan should be used. A recent SIGN guideline gave very similar advice. Sacubitril valsartan is a combination drug. It includes the angiotensin 2 receptor blocker (ARB), valsartan. It also includes the neprilysin inhibitor, sacubitril. Neprilysin inhibition leads to increased levels of vasoactive proteins, which leads…
Read more

Routine pre-operative tests and blood pressure

These are two guidelines, but both on the topic of pre-operative testing, so they fit nicely together. I am just pulling out the points useful for us GPs. Pre-operative tests This is a new guideline from NICE on what tests are required pre-operatively. Most of it is obviously for secondary care, but there are a…
Read more

Nice | New treatments for migraines and sinusitis

These are 2 new guidelines from NICE. I thought it was interesting to know that they are out there, but we don't need to know much about them at this stage. Transcutaneous stimulation of the cervical branch of the vagus nerve for cluster headache and migraine. This is safe, but there is limited evidence of…
Read more

RCOG | Endometrial hyperplasia

This is a new guideline from RCOG on diagnosing and managing endometrial hyperplasia. This is a very common condition, so highly relevant for us and I had no idea on some of the management options. I am therefore doing a general summary. Types Endometrial Hyperplasia without atypia - fewer than 5% will progress to cancer…
Read more

RCOG | Ovarian Hyperstimulation Syndrome

This is a new guideline from the RCOG on managing ovarian hyperstimulation syndrome (OHS). Most patients will ultimately be managed in secondary care, but we need to be aware of it, as most women apparently attend the GP first. Two important points if you read no further! Most women present with abdominal pain and distention after…
Read more

Nice | Nalmefene for reducing alcohol consumption

This is a guideline on Nalmefene from NICE; they originally advised that Nalmefene could be used in Nov 14. This lays out how. It is an opioid receptor modulator and can help to reduce alcohol consumption in people with alcohol dependence. People should: be drinking at a 'high drinking risk level' (7.5 units a day…
Read more

Nice | Tuberculosis (TB)

This is an updated guideline from NICE on managing tuberculosis. I guess the relevance will be largely related to where you work. There isn't any really big change here, but there are lots of things that I wasn't aware of, so I will do a general summary of the guideline. There is a lot more detail…
Read more

Nice | Type 2 diabetes in adults

This is an update of the last Nice guideline on type 2 diabetes in adults, which was published in 2009. I am just summarising things that have changed since the last update. If you don't want to read anything else, just be aware that Nice has produced an excellent single A4 summary of what drugs to…
Read more

Nice | End of Life care

This is a new guideline from NICE on end of life care. You may have heard it widely reported in the news, given all the attention over the Liverpool Care Pathway. What was reported as being different was the focus on communication with the patient and delivering an 'individualised' approach. This is really the biggest part…
Read more

Nice | Managing discharge from hospital

This is a new guideline from NICE giving advice about managing discharge from hospital safely. Most of this we already do. There are a couple of points worth noting: Patients felt to be at risk of re-admission need a GP or nurse visit or phone call 24 - 72 hrs after discharge. Palliative care patients…
Read more

Nice | Managing the menopause

This is a new guideline from Nice on managing the menopause, both in women undergoing premature ovarian failure and in women going through it at a more normal age. There isn't much earth shattering in this, but they are encouraging us to offer HRT routinely and to avoid doing unnecessary FSH tests. I'll highlight what…
Read more

Home care for older people – NASGP

This is a new guideline from NICE on homecare for older people. Most of this isn't new, or is aimed at other health professionals, but there are a couple of points of note for us. Care Coordinator. Nice advise considering organising a named care coordinator. This would normally be a social worker, a practitioner working for…
Read more

Recent Comments by Louise Hudman

No comments by Louise Hudman yet.