NB Hot Topics Podcast (NB Medical Education)

After not being out the house for 13 days due to him and the kids having covid, Neal Tucker uses the Hot Topics podcast for a bit of escapism.

Apart from singing the blues, in this podcast we discuss the latest medical news including reports of racism in the NHS, government calls for nationalisation of general practice and the negative effects of pandemic priorities on routine care from the National Diabetes Audit.

Meanwhile in the journals we look at two papers demonstrating the effectiveness of new acute covid treatments on non-hospitalised patients but ask the question: is it worth it? And two papers showing how continuity may be more effective than any medication in improving patient outcomes. Too good to be true?

Let us know what you think on email hottopics@nbmedical.com, twitter @gphottopics or GP Horizon.

References

Racism in the NHS BMA survey report
Government plans to nationalise general practice
National Diabetes Audit report
Remdesivir in non-hospitalised covid patients
Casirivimab and Imdevimab in asymptomatic covid patients
What are GPs for, when the chips are down?
The invisible GP
A call to charity
Continuity of care in Norway
Continuity of care on dementia outcomes

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In the latest Hot Topics podcast with Dr Neal Tucker, we reflect on the government removing covid measures and how this affects general practice. 

In research, we have a look at a timely BMJ paper on the accuracy of lateral flow tests? As we prepare to stop testing, does the data provide us with some reassurance? We also have a look at a new way of assessing the risk of DVT and whether it can safely identify low-risk patients and reduce referral rates. And remember Zika? A new paper in the NEJM highlights to risks for children exposed to zika in utero.

References

BMJ Accuracy of Covid LFTs
BMJ Diagnosing DVT
NEJM Zika infant mortality

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In the Hot Topics podcast, Neal Tucker discusses the latest primary care news and research.

This week:

• Reflecting on NHS England's PCN stipulations - general practice finds itself in a lose-lose situation. Is it a coincidence it comes just as a think tank backed by the health secretary pushes for all GPs to be salaried? 
• Research:
  • Hamsters can give you covid. What should we do? Lancet
  • The Triple F*** Syndrome - a different way to think about personality disorder? BJGP
  • What do young people with mental health issues value from general practice and what helps. BJGP 
  • Durability of maternal COVID antibodies in infants - is natural infection or vaccination best? JAMA

Also, keep a look on the website www.nbmedical.com for our free Migrant Health webinar Tuesday 26th April at 7:30 pm.

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Welcome to another Hot Topics podcast with Dr Neal Tucker.  In this busy edition, we discuss whether national guidelines are affected by bias against race or ethnicity, potentially driving health inequalities. GP and researcher Dr Dipesh Gopal joins us for an interview to examine issues around NICE hypertension guidance.

In new research, we have papers on whether a 4th covid vaccine dose actually provides additional protection, how long patients remain at increased risk from acute covid complications after infection, whether breast pain and cancer are linked, how women feel about delayed antibiotics for UTI and what is the optimum dose schedule for iron supplementation in anaemia.

Next podcast we'll be interviewing the founder of the Greener Practice network, which has just published a new website - www.greenerpractice.co.uk - full of useful resources to make GP more sustainable and environmentally friendly. Back after Easter.

References

1. Lancet editorial on Ockenden report
2. Kings Fund review of NHS Patient Satisfaction survey
3. BJGP Breast pain and cancer
4. BJGP Non-antibiotic treatment of UTI
5. BJGP Iron supplementation review
6. BMJ Risk of VTE/bleeding post-covid
7. NEJM 4th dose covid vaccine
8. Greener Practice website

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In the latest Hot Topics podcast from NB Medical Dr Neal Tucker discusses the latest research important in primary care and interviews two experts in improving asthma care and sustainable healthcare.

In new research we examine:

•  The role of self-monitoring of BP in women with hypertension or higher risk of pre-eclampsia - does it provide early detection?
• Do ezetimibe and PCSK9 inhibitor provide additional real-world benefits over statins alone? Which is best?
• Can an oral biological agent, baricitinib, provide some hope for patients with severe alopecia?

We are also joined by Dr Aarti Bansal and Dr Veena Aggarwal to talk about improving asthma care with a new Asthma Toolkit from Greener Practice and healthcare sustainability in the UK. Why are our asthma outcomes poor? Can simple measures improve care? What is the NHS doing to help primary care reduce its carbon footprint?

If you want more join us for our FREE NB Clinic on Tuesday 17th May, 8pm, for Improving Asthma Care and Thinking Green.

Resources

Greener Practice Asthma Toolkit
JAMA Self-monitoring of BP in Pregnancy
BMJ Ezetimibe and PCSK9 inhibitors for Reducing CVD Risk: network meta-analysis
BMJ Lipid-lowering medication Rapid Recommendations
NEJM Baricitinib for Alopecia
Faculty of Medical Leadership and Management Fellowship webpage
BMJ Open Cost of Switching Asthma Inhalers

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Welcome to the latest Hot Topics podcast with Dr Neal Tucker.  This week we think about monkeypox. Do we need to worry? What do we need to look out for? Can my pet rat give it to me?

Beyond a disease very few of us are likely to ever see, we look at new research on improving mobility in people with frailty and sarcopenia - can exercise classes and nutrition make a real-world difference?

We consider a BJGP paper on preventative medicine - why don't we do more, what are the barriers and what really works?

Our final piece of research examines whether treating mild hypertension in pregnancy is beneficial or detrimental to mother and baby. Are the NICE guidelines right?

References

Monkeypox info UK gov & WHO
BMJ Maintaining mobility in older people with frailty
BJGP Prevention in practice
NEJM Treating mild hypertension in pregnancy
NICE Guideline on chronic hypertension in pregnancy

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In this new episode of the Hot Topics podcast from NB Medical.  Dr Neal Tucker reflects on a busy week in the politics of UK general practice: "plans for change" from the English health secretary, but the head of primary care for NHSE says partnerships aren't going anywhere. Meanwhile, Panorama highlights the challenges for private companies running NHS GP practices. Where will it all end up? Answers on an e-consult, or email us at hottopics@nbmedical.com.

Meanwhile, there is some research! Important new data from the BJGP on the accuracy of the NICE traffic light system for fever in <5yos suggesting those old GPs might have been right all along; also can internet-based therapy for PTSD be as good as traditional therapy? And is there any role for opioids post-surgery?

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Welcome to another Hot Topics podcast from NB Medical with Dr Neal Tucker leading you through the latest news and research in general practice.  Of course, we must touch on the demise of Boris Johnson and how he might still be in power if he'd just learned a thing or two from general practice.

Meanwhile, in research, we look at prescribing trends in anxiety disorders, whether bariatric surgery can reduce cancer risk in overweight people, and two papers on covid vaccination against Omicron, first on efficacy in kids, second on the relative merits of vaccination vs natural immunity,  plus could a new vaccine for RSV be just around the corner?

And with hot weather finally coming to the UK,  time to remind ourselves about the symptoms and signs of heat-related illness in our KISS from NB.

References:

BJGP Trends in anxiety medications
JAMA Bariatric surgery and cancer risk
NEJM Covid vaccine in kids
NEJM Covid vaccination vs natural protection vs hybrid immunity
NEJM RSV vaccine study

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Welcome to a new Hot Topics Podcast from NB Medical with Dr Neal Tucker.  It's the summer holidays! We hope a little pressure is off at your practices and you might even get a break yourself. 

In this podcast, we discuss the latest news including whether GPs simply aren't working hard enough and debate a £10 charge for DNAs.

In research, we look at new data from JAMA suggesting patients are at increased risk of MI shortly after a flare of gout, a fantastic paper in the BJGP presenting data showing how it may be possible to improve early identification of colorectal cancer based on common symptoms and blood results, and more from the BJGP with qualitative research exploring the barriers to shared decision making in patients with multimorbidity.

References

JAMA Gout and acute CVD
BJGP Early Identification of CRC
BJGP Shared decision making and multimorbidity

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Welcome back to the new series of the Hot Topics podcast from NB Medical with Dr Neal Tucker.  A sober start with the death of the Queen yesterday and reflecting on the pressures of general practice and the profoundly sad story of Gail Milligan. 

But the progress of medicine never stops and there is research to discuss:

• Papers in the BMJ on whether artificial sweeteners cause harm, and whether supplementing vitamin D really does reduce respiratory and covid infection risk.
• A Lancet paper on autoimmune disease and an increase in cardiovascular risk, but in whom and how much?
• Another Lancet paper on the actual rates of statin-induced muscle pain (a little but not a lot...)
• And a NEJM on whether hacking diabetes monitors and insulin pumps is a safe thing to do.

Plus until the 12th of September, we have our Back to School NB Plus offer which you can find here.

References

BMJ Sweeteners
BMJ Vit D
BMJ Cod liver oil
Lancet autoimmune & CVD risk
Lancet statins & muscle pain
NEJM Open-source automated insulin delivery systems

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Welcome to the new Hot Topics podcast from NB Medical with Dr Neal Tucker.  After a whirlwind week where general practice has been populistically politicised on all sides, in this episode we stay on safer ground and look at new research.

The BMJ highlights the future risk of cardio- and cerebrovascular disease after gestational diabetes, even without overt diabetes, but offers some good news regarding the optimisation of risk factors. JAMA introduces roflumilast for chronic psoriasis, as a cream, not a tablet. And the NEJM explores whether there is a role for bronchodilators in people with COPD who don't have COPD - symptomatic smokers with preserved lung function.

References

Best research title of the podcast award
BMJ GDM and CVD risk
BMJ GDM and modifiable risk factors
JAMA Roflumilast for psoriasis
NEJM Bronchodilators for smoking Sx with preserved lung function

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Welcome to a new NB Hot Topics Podcast with Dr Neal Tucker.  Amongst all the political turmoil, healthcare must go on. 

In this episode, we look at:

• The new government report (someone's still working, for better or for worse) on the Future of General Practice
• The implications practices need to be aware of for Patient Record Access starting 1st November
• New research on the best time to take BP meds and whether cardiovascular screening using CTs & more is helpful.

References:

Future of GP Report
Lancet TIME study
NEJM CVD Screening in Danish Men

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Welcome to the new Hot Topics podcast from NB Medical with Dr Neal Tucker.  We're dealing with heavy topics today - the Autumn Statement, how losing continuity is detrimental to patient care, maternal mortality in the UK - but we've tried to keep it light in other ways including our new segment: Just One More Thing

In Just One More Thing we interview primary care experts across a range of specialties asking 3 questions: what one thing do we need to know about in general practice regarding your specialty, what one thing do we need to know about that's happening in secondary care, and what is pushing the boundaries of medical care in your field. This week we talk to Dr Sarah Davies about diabetes.

In research, we consider the implications of two BJGP papers on correlations between practices and patient continuity, while in the BMJ this week a new paper highlights a significant discrepancy in maternal mortality ratios between 8 European countries. Are there lessons for general practice here?

Resources

BJGP Continuity paper no.1
BJGP Continuity paper no.2
BJGP Editorial
BMJ Maternal Mortality paper
BMJ MM Editorial

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Welcome to a new episode of the Hot Topics Podcast from NB Medical with Dr Neal Tucker.  In this podcast, we look at new research in the BMJ on optimal duration to treatment distal DVTs (wait... do we even check for these...?), and the Lancet examines the benefits of high-dose chronic heart failure therapies after acute decompensation.

In Just One More Thing... this episode we are joined by Dr Rachel Ainley, head of research and evidence at Crohn's & Colitis UK to find out what's new in Inflammatory Bowel Disease. You'll find links to the RCGP IBD toolkit and C&CUK's awareness campaign below.

References
RCGP IBD Toolkit
C&CUK Professional Resources
BMJ Distal DVT paper
Lancet Post-Acute Heart Failure Dosage

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Welcome to the latest NB Hot Topics podcast. It’s Christmas and no one needs anything too serious. Enjoy the song. Happy holidays everyone! See you in 2023.
Neal

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Welcome to another HOT TOPICS podcast from NB Medical with Dr Neal Tucker.  In the podcast cast we reflect on the latest commentaries from the political parties and medical organisations on how they can help with the NHS crisis. We can’t promise a solution, but we can help you stay up to date with the world of research.

This week we have new research in the Lancet examining whether molnupiravir actually helps acute covid, whether dementia can be prevented through a healthy lifestyle even if you have high risk genes, and what patients actually feel about FIT tests and we the way we use them in GP.

For our latest courses and much more go to www.nbmedical.com

References

Lancet acute covid treatment
BMJ Dementia and healthy living
BJGP Patients perspective on FIT

www.nbmedical.com/podcast

Welcome to the Hot Topics podcast with Dr Neal Tucker.  In this episode, we speak to Dr Katherine Hickman, current chair of the Primary Care Respiratory Society, who answers our three Just One More Thing questions on what we need to know about from primary, secondary and future care with asthma.

In new research, we discuss a paper on how pharmaceutical companies spend more money promoting less effective drugs, how atropine eye drops in children can delay myopia, and whether cancer risk prediction tools are accurate in cancer survivors with their inherently raised CVD risk.

www.nbmedical.com/podcast

References

Primary Care Respiratory Society - if you want to know more!
JAMA Drug spending on low clinical benefit drugs
JAMA Atropine eye drops in kids to delay or prevent myopia
Lancet CVD risk prediction tool accuracy in cancer survivors

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Welcome to the Hot Topics Podcast with host, Dr Neal Tucker.  In this bumper edition, we have the next in our Just One More Thing series. We interview Dr Sam Merriel in collaboration with Prostate Cancer UK, talking about what we need to know in the world of prostate cancer. Should we be screening? Do we need to think beyond PSA? Does new technology change our approach?

In the news, we look at the latest RCGP data on workload and whether GPs will strike, while in research we have a BJGP paper on why antimicrobial stewardship interventions may not have the impact in real life that they do in trials, a BJGP analysis of nitrofurantoin (and other antibiotic) failure in men with UTI, and a NEJM paper testing whether thiazides help renal stones.

References:

Free on demand NB Clinic with Prostate Cancer UK, March 2022
PCUK Resources for Health Professionals
PCUK Resources for Delivering the PCN DES
PCUK 30 second Risk Checker for Patients
Research discussed by Sam Merriel
...Lifetime risk of PCa by major ethnic group in England
...Family history risk for PCa
...Genetic risk scores for PCa in patient with LUTS
BJGP Implementing Antimicrobial Stewardship in GP
BJGP Nitrofurantoin failure in men with UTI
NEJM Hydrochlorthiazide and renal stones

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Welcome to the latest Hot Topics podcast from NB Medical with Dr Neal Tucker.  In this episode, we have the latest news including how the public view the NHS and what's happening to the GP contract for English practice.

In research, we have a fascinating paper in the BMJ exploring what differences have emerged in recorded outcomes between England and Scotland since the latter abolished QOF, an answer on whether coffee is bad for you (or at least your heart in the short term), and a new class of drug to help with vasomotor symptoms in menopause.

Resources

BMJ QOF paper
NEJM Caffeine and the Heart
Lancet Fezolinetant and hto flushes
NHSE GP is the best job ever page

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Welcome to another Hot Topics podcast from NB Medical with Dr Neal Tucker. With general practice becoming an increasingly popular political battleground, we focus on the latest research.

In this edition, we look at whether bempedoic acid actually reduces cardiovascular events and death as well as reducing cholesterol. Ever wondered which is more important in causing CVD: inflammation or cholesterol? A new paper in the Lancet examines this in patients already taking statins. We also explore what is best to drink if you (or your patient) have type 2 diabetes. Can coffee and tea actually be good for you?

www.nbmedical.com/podcast

References

NEJM Bempedoic acid
Lancet Inflammation vs chol in CVD
BMJ what to drink in T2DM

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Welcome back to the Hot Topics podcast.  In this episode we reflect on the Prime Ministers Primary Care Recovery Plan, then move on to more useful things like research.  We have new papers in the BJGP on who may be more likely to develop fatigue after mild covid and the NEJM on using a peanut patch to desensitive toddlers at risk of anaphylaxis.

We also have the next in our series of Just One More Thing - this time we chat about allergy with Dr Matt Doyle, GP and chair of the primary care committee of the British Society of Allergy and Clinical Immunology.

References

BSACI website
Prime Ministers Primary Care Recovery Plan
BJGP Post-covid fatigue
NEJM Peanut allergy patch

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Welcome to a new Hot Topics podcast from NB Medical with Dr Neal Tucker. In Just One More Thing we are joined by Dr. Jim Moore, chair of the Primary Care Cardiovascular Society, where we discuss cholesterol lowering therapies, new ways to treat heart failure, and how we may meet government targets for blood pressure control - can and should it all be done in general practice?

In news, is it good news as GPs are primed to solve the obesity crisis with semaglutide? And in research we look at a BMJ paper hoping to radically change how we monitor patients taking methotrexate, and in JAMA a new paper looks at strategies for helping patients stop opioids for chronic pain.

Resources

Primary Care Cardiovascular Society website
BMJ Methotrexate monitoring
JAMA Chronic opioid withdrawal
My Opioid Manager

Podcast Transcript

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Welcome to the Hot Topics podcast from NB Medical with Dr Neal Tucker.  NHS Long Term Workforce Plan is all over the news today. In this episode we have a look at some of the key statements, seeing what is positive for general practice, what is wishful thinking, and what could be even worse.

In research we look at new observational data from Denmark, published in the BMJ, finding an association between HRT and dementia; also a study examining the effectiveness of an intra-pulmonary artery device for identifying earlier deterioration of heart failure; and two papers in the NEJM on more weight loss medications for obesity.

References

NHS Long term workforce plan
BMJ HRT & dementia
Lancet HF device
NEJM Retatrutide & Orforglipron

www.nbmedical.com/podcast

Welcome to the Hot Topics podcast from NB Medical with Dr Neal Tucker.  School's out for summer but general practice never stops. This week we look at the medical news story of the week: donanemab for Alzheimer's disease - can this monoclonal antibody revolutionise dementia care?

Also in research, prevention is better than a cure, so can a Mediterranean-DASH diet keep cognitive decline at bay? For you weekend warriors out there, is cramming exercise into the weekend as good as exercising throughout the week. A new paper in JAMA answers this question. And is there ANY role for opioids in acute back pain? A new Australian study goes strong to see if there is benefit with this common problem.

Don't forget to check out all our upcoming courses including the new Hot Topics course in September and much more on www.nbmedical.com.

References

JAMA Donanemab
NEJM MIND diet for dementia prevention
JAMA Weekend warriors and CVD risk
Lancet Opioids for Low back and neck pain

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Welcome to the Hot Topics podcast from NB Medical with Dr Neal Tucker.  Wondering where the sunshine is? Then this song is for you. Have a good summer everyone and the podcast will be back in September.

In the meantime have a look at www.nbmedical.com for our latest courses - we have live webinars for the new Hot Topics course, our new Paediatrics and Child Health course, our updated dermatology course and much more in September.

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Welcome to Season 5 of the Hot Topics podcast from NB Medical with Dr Neal Tucker. Despite celebrating our 25th birthday (don't forget to check out our NB Plus birthday special here) the world of medical news and research never stops.

In this episode we look at research in the BJGP about the motivations behind being a GP, whether adding NSAIDs may improve efficacy of emergency contraception, and whether we should be worried about cancer in patients with reflux.

www.nbmedical.com

References

BJGP Mapping GP Motivations
Lancet Levonorgestrel + piroxicam for EC
BMJ Non-erosive reflux and oesophageal cancer risk

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Welcome to the Hot Topics podcast from NB Medical with Dr. Neal Tucker. As we celebrate 25 years of NB Medical and the Hot Topics course, in this podcast we chat with co-founder Dr Simon Curtis about the changes in general practice and medical education since its inception, we discuss three of the most influential research papers over the era, and what the future may hold for GPs.

In research, we examine two new papers. The first in the NEJM is on semaglutide for patients with heart failure and preserved ejection fraction. Can it help improve symptoms and quality of life? Could it improve mortality? The second paper from the Lancet looks at a practice nurse-delivered insomnia intervention using sleep restriction therapy. Could this be a useful, cost-effective option for helping people struggling to sleep?

References

NEMJ Semaglutide + HFPEF with obesity
Lancet Nurse-led Insomnia intervention 

www.nbmedical.com/podcast

Welcome to the Hot Topics podcast from NB Medical with Dr Neal Tucker. In this episode we talk to Dr Jessica Watson, lead author of the Why Test study, published in the BJGP exploring the use of blood tests in general practice and how often they make a difference - positive or negative.

In other research we look at a BMJ paper comparing rosuvastatin and atorvastatin for secondary prevention, and in the Lancet, the PATHFINDER study, exploring the role of multi-cancer early detection blood tests - will this be useful for diagnosing cancers earlier?

Plus the usual news, views, and a song about vaccinations.

www.nbmedical.com/podcast

References

BJGP Why Test Study
PACT - primary care academic collaborative website
BMJ Rosuva vs Atorva for secondary prevention
Lancet PATHFINDER MCED study
Lancet Editorial
RCGP Manifesto Seven Steps To Rebuild General Practice and Save the NHS

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Welcome to the Hot Topics podcast from NB Medical with Dr Neal Tucker. The highlight of this episode is our interview with Prof Miriam Santer, lead author of recent research in the BMJ exploring the effectiveness of spironolactone for acne in women.

Does it work? Is it a treatment for general practice? And if so, is it safe, what monitoring is required, and where does it fit with current acne pathways?

In the news, we think about the current issues around physician associates in general practice. In research we have two papers on diabetes: first, in the Lancet, is a new once-weekly insulin injection as effective as a daily treatment for type 1 diabetes; and second, in JAMA, is the additional tirzepatide better than prandial insulin in addition to glargine for managing type 2 diabetes?

References

Eczema Care Online
BMJ Spiro for acne
Lancet Once weekly insulin vs daily insulin in T1DM
JAMA Tirzepatide vs prandial insulin in T2DM

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Welcome to the Hot Topics podcast from NB Medical with Dr Neal Tucker. In this episode, we talk to Prof Hazel Everitt, a GP and lead author of a recent Lancet paper exploring whether amitriptyline is effective for IBS, and where it might fit in to general practice management.

We also look at research in the Lancet on treating hand osteoarthritis with methotrexate - what's the rationale and does it work? - plus a BMJ paper on using a patient information leaflet to improve lower urinary tract symptoms in men. Are PILS better than pills?

Resources

Lancet ATLANTIS paper on IBS & amitriptyline
ATLANTIS trial website with patient information
Gut journal CBT for IBS
National Institute for Health and Care Research - how to get involved
NIHR Local research groups - how to get involved
Lancet Methotrexate for hand OA with synovitis
BMJ Leaflets for LUTS

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Welcome to the Christmas Hot Topics Podcast from NB Medical with Dr Neal Tucker. It’s time for a bit of light-hearted festive fun so if you’ve finished signing all your scripts for Christmas then join us for a discussion with Dr Stephen Bradley and Dr Alice Harper about “Great Expectations: GPs estimations of time required to deliver BMJ’s 10minute consultations”.

This new paper explores how long it REALLY takes to do everything that’s recommended in clinical guidance. If you’ve ever felt like there just isn’t enough time in your general practice day, this might explain it, and you are not the only one.

Merry Christmas everyone, see you in the New Year. Neal

References

Great Expectations: GPs estimations of time required to deliver BMJ’s 10minute consultations

The Health Foundation: Identifying Operational Failures in General Practice

BMJ Guidelines should consider clinicians time needed to treat

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Welcome back to the Hot Topics podcast from NB Medical with Dr Neal Tucker. In this episode, we consider the current state of general practice in the UK and what lessons the countries can learn from each other.

We examine a new paper in the BJGP on how patients feel about general practice in Scotland since the introduction of the 2018 GP contract. Is it meeting patient and policymaker goals?

In other research, we see what lessons a new paper in JAMA on weight loss and cancer association can tell us about a seemingly obvious connection, and from the NEJM what effect testosterone replacement for hypogonadism has on men's fracture risk.

References

BJGP Patient experiences of Scottish GP paper
BJGP Family physician's moral distress when managing health inequalities
JAMA Cancer diagnoses after weight loss
NEJM Testosterone replacement for hypogonadism and fracture risk

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Welcome back to the Hot Topics podcast from NB Medical with Dr Neal Tucker. In this episode, we think about the pay offer for practices in England, a new King’s Fund report on the under-funding of primary care for three decades, and the introduction of Pharmacy First. 

In new research, we have two papers. First, in the BMJ, can an online combined exercise and psychological programme improve quality of life for patients struggling after hospitalisation with covid? Second, in JAMA, can serum urate levels help predict future flares of gout and guide us on who might benefit the most from urate-lowering therapy

References

Kings Fund Report on Primary Care

BMJ Post-covid-19 syndrome and online programme

JAMA Serum urate and recurrent gout

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Welcome back to the Hot Topics podcast from NB Medical with Dr Neal Tucker. In this episode we think about another year of imposed GP contract on practices in England, the BMA response and where it may lead. 

In research, we have three fascinating new papers. Firstly, a paper examining how to maintain weight loss after a low-calorie diet – is structured exercise, liraglutide or both better than usual care? Secondly, in the BMJ a systematic review exploring whether exercise should be considered a genuine treatment for depression. And finally, in the NEJM, a study looking at the link between microplastics in carotid arterial plaques and subsequent risk of cardiac vascular events (hint: it’s not good news…).

References

BMA GP Contract Changes 2024/25

Pulse Editorial

Lancet Discovery Science paper on weight loss maintenance

Weight maintenance author interview

BMJ Exercise and Depression

NEJM Micro/nanoplastics in your arteries

NEJM Microplastics editorial

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Welcome back to the Hot Topics podcast from NB Medical with host Dr Neal Tucker. In this episode, we start by thinking about the news. Firstly, the overwhelming consensus from GPs in England to not support the imposed contract.

Secondly, the ongoing discussion around physician associates in general practice, where we touch on an interesting report from South Mississippi around the costs and other outcomes of non-doctor-led primary care. Thirdly, NHS patient satisfaction - is important to take note but why does staff satisfaction never hit the headlines?

In research, we look at two papers. First, the rate of familial hypercholesterolaemia coded in practices - how far are we away from what we should expect? And in those with a diagnosis, how good are we at optimally treating them? Second, a paper on which interventions might help people maintain their independence. After an estimated £1.15 billion pounds of research in this area, what does this new systematic review and network meta-analysis tell us?

References

AMA Report on PA/NA from South Mississippi
NHS Staff Survery Results
BJGP Familial Hypercholesterolaemia rates in GP
NICE Guideline FH
Simon Broome Diagnostic Criteria for FH
BMJ Community Interventions to Maintain Independence

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Welcome to the Hot Topics podcast from NB Medical with Dr Neal Tucker. To DRE or not to DRE? This is the question and the main event in this episode.

We have a fantastic interview with Amy Rylance, Head of Improving Care at Prostate Cancer UK, and Sam Merriel, GP and academic clinical lecturer, discussing their recent Clinical Practice paper in the BJGP: Is the digital rectal exam any good as a prostate cancer screening test?

In other research, we have two papers with a common theme. Firstly, a paper in the BMJ looking at long-term outcomes after diagnosis with atrial fibrillation, and secondly, a paper in the BJGP examining the role of BNP testing as a marker for future cardiovascular disease in patients with a new diagnosis of hypertension. Both show that while these conditions make us think of stroke and MI, we also should be thinking about heart failure.

Resources

BJGP Clinical Practice paper on DRE for prostate cancer screening
Prostate Cancer UK Patient Risk Checker
European Urology Oncology Journal Performance of DRE in PCa Screening
NEJM 2004 Prevalence of PCa in men with a PSA <4
BMJ AF and future risk paper
BJGP HT and future risk paper

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Welcome to the Hot Topics podcast from NB Medical with Dr Neal Tucker. In this episode we think about the GP workforce courtesy of four papers in this month's BJGP - does more GPs boost life expectancy (of the patients...)? do PCNs help health inequalities? is practice-based continuity as good as individual continuity?

For a more directly clinical update, we look at new research in the BMJ on which is the best oral option in T2DM after metformin. Can the SGLT2 inhibitors prove their worth?

References

BJGP Does the shortage of GPs matter?
BJGP PCNs, deprivation and funding
BJGP Continuity in GP
BJGP Continuity in Norwegian GP
BMJ Best drug after metformin in T2DM

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Welcome to the Hot Topics Podcast from NB Medical with Dr Neal Tucker. It's election time but we're going to put aside politics and focus on the latest medical research!

In this episode, we look at an important BJGP paper highlighting the rates of follow-up after a significant asthma attack, a paper in the Journal of Infection showing the high rates of second antibiotic prescription in ongoing cough, and a RCT in JAMA examining if, as suggested by observational data, aspirin can truly prevent recurrence or metastasis of breast cancer.

References

BJGP Post-hospitalisation asthma management in primary care
BJGP  Editorial Asthma Deaths in Children
J of Infection Repeat Antibiotics for Cough
eCancer Aspirin for Cancer
JAMA Aspiring & Breast Cancer Recurrence

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Welcome to a new episode of the Hot Topics Podcast from NB Medical with Dr Neal Tucker. Today is election results day but we're not talking about politics, we're focusing on the research.

We look at a paper in the latest BJGP which looks at which factors influence a patient's decision to discontinue anti-depressants, explore a paper in the Lancet on whether a symptom-clinic led by GPs can improve outcomes for patients with multiple and persistent symptoms, and discuss trends in cardiovascular disease in the UK over the past 20 years, published in the BMJ this week.

References

NB Blog on Discontinuation of Antidepressants
BJGP Discontinuation of antidepressants
Lancet Symptom clinic
BMJ CVD trends

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Welcome to the Hot Topics podcast from NB Medical with Dr Neal Tucker. Have you ever walked into a pharmacy and wondered whether those nasal sprays suggesting they can stop the common cold actually do anything?

Ahead of the inevitable coughs and colds of the autumn, the Lancet Respiratory provides some answers and they won’t be the ones you think... Still, right now it's the summer and time to get outside and active - especially if you have recurrent back pain. We look at a paper in the Lancet exploring whether just simply walking can be the problem. Finally, from the BJGP we examine a paper looking at what being a "full-time GP" means and how, sometimes, definitions can be REALLY important.

Resources

BJGP Trends in Full-Time Working in GP
Lancet Effectiveness of Walking for Back Pain
Lancet Resp Nasal Sprays for URTIs

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Welcome to Season 6 of the Hot Topics podcast with Dr Neal Tucker. The summer holidays are over and it’s back to work so time for a new podcast.

In this episode, we look at research on whether SGLT2i might prevent dementia, on if it is safer to de-escalate sooner rather than later from dual anti-platelet therapy post-MI, and how effective is the new RSV vaccine at preventing hospitalisation in older people.

References

BMJ - SGLT2i & dementia
Lancet - De-escalation of DAPT post-MI
JAMA - RSV Vaccination Efficacy in Older People

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Welcome to the Hot Topics podcast from NB Medical with Dr Neal Tucker. In this episode, we have three exciting new papers.

Firstly, in the BMJ a network meta-analysis on acute migraine treatments - can the new GEPANTs drugs beat existing therapies? Secondly, a paper in NEJM does screening for prostate cancer using MRI actually help? Finally in the BJGP can first contact physio be better than a GP appointment? Listen on!

References

BMJ Acute migraine therapies
NEJM Prostate cancer screening with MRI
BJGP First contact physio in GP

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Welcome to the latest Hot Topics Podcast from NB Medical with Dr Neal Tucker. In this episode, we look at two new papers on the drugs de jour: GLP1 receptor agonists and SGLT2 inhibitors. Can the former reduce pain in knee osteoarthritis and can the latter prevent recurrent renal stones?

Our third paper is a consensus paper published in the BJGP on optimising PSA testing for the early detection of prostate cancer in asymptomatic men. Sponsored by Prostate Cancer UK, Neal is joined by Dr Alex Norman, a GP, and Dr Oliver Hulson, a consultant radiologist who undertakes prostate biopsy, to discuss the outcomes of this paper and the latest research in this area. For further information from Prostate Cancer UK including educational resources and webinars see the links below.

References

NEJM Semaglutide & knee OA
BMJ SGLT2i & renal stones
BJGP Consensus Paper on PSA Testing in Asymptomatic Men
NB Podcast on role of DRE in identifying prostate cancer
PCUK Prostate Cancer Education for Health Professionals
PCUK Consensus Paper Webinar

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Welcome to the Hot Topics podcast with Dr Neal Tucker. This is the first in a series of special podcasts where we talk to the movers and shakers of general practice.

We will talk to people in GP politics, leadership, media and research and discuss how their careers evolved, how they see current general practice and how they may be influencing the future of the specialism.

We start with Dr Claire Fuller, GP and current primary care medical director for NHS England. Hugely influential, you will probably know her as the author of the Fuller Stocktake report. We discuss how she came to the job, what this report found, and how it is impacting general practice in England. 

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Welcome to the Hot Topics podcast from NB Medical with Dr Neal Tucker. In this edition, we look at three new research papers.

Firstly, can eating chocolate actually reduce our chance of type 2 diabetes? Sounds too good to be true... Secondly, could a blood test predict your 30-year cardiovascular risk? Finally, how does general practice access going digital affect minoritised ethnic populations?

Look out next week for the second of our special interviews. We talk to Dr Katie Bramall-Stainer, chair of the GPC in England, about what does she hope general practice will look like in the future and the effects of collective action in England.

References

BMJ Chocolate vs diabetes
NEJM 30 year CVD risk prediction
BJGP Digitalising GP access and minoritised ethnic populations

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Welcome to the Hot Topics podcast with Dr Neal Tucker. This is the second in a series of special podcasts where we talk to interesting and influential people in general practice.

In this interview we talk to Dr Katie Bramall-Stainer, GP and chair of the BMA GPC England, who is currently leading much of UK general practice through 'collective action'. We talk about her career and how she came to her current role, about the BMA collective action in England and what impact this is achieving, and what is the end goal for general practice in England.

www.nbmedical.com/podcast

References

BMA GP Collective action site

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Welcome to the Hot Topics podcast from NB Medical with Dr Neal Tucker. It's Christmas time and that means a song to get you in the festive spirit. We'll be back with the regular podcast in the New Year. 

Happy holidays everyone!

Neal

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Welcome to the Hot Topics podcast from NB Medical with Dr Neal Tucker. A belated Happy New Year! In our round-up of new research, we look at three papers.

Firstly, what have been the effects of increased hybrid working in general practice, particularly with the introduction of digital tools and triage?

Secondly, do patient decisions aids help patients with choices on anticoagulation in AF and does this help us?

Finally, can appendicitis be safely treated with antibiotics and could we be doing this in general practice soon?

References

BJGP Hybrid working in general practice
BMJ Patient decision aids in AF
Lancet Appendicectomy vs antibiotics in kids

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Welcome to the Hot Topics podcast with Dr Neal Tucker. This is the third in our series of special podcasts where we talk to interesting and influential people from the world of general practice.

In this interview, we talk to Dr Euan Lawson, GP and editor of the BJGP.

The journal will be familiar to all clinicians in general practice and has gone from strength to strength over the past few years. We talk about his career and how he became editor, discuss the world of research including the most influential papers published during his tenure, consider the importance of inclusion health in the changing face of GP, and discuss his vision for the future.

And remember our recent NB Clinic in Inclusion Health can be watched on demand here.

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Welcome to the Hot Topics podcast from NB Medical with Dr Neal Tucker. This week we look at three new pieces of research.

First, we have a paper in the BMJ exploring arterial thrombosis risk with modern hormonal contraceptives including newer treatments such as the combined patch and ring. Second, we have a BJGP paper looking at which type of safety net advice is the most effective. Finally, a new paper in JAMA Internal Medicine collates trials on anti-virals for influenza. Can any of them provide genuine benefit? 

And don't forget our NB Plus offer - £25 discount on an annual subscription until the 17th of February.

Resources

BMJ

BJGP

JAMA

Healthier Together patient info

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Welcome to the Hot Topics podcast with Dr Neal Tucker. This is the fourth in our series of special podcasts where we talk to interesting and influential people from the world of general practice.

In this interview, we talk to Dr Helen Salisbury, GP & BMJ columnist.

A working GP for more than 20 years, Helen has also reached the wider medical community through her regular column in the BMJ. A fierce advocate for general practice, we talk about her career, how general practice has changed over the past 20 years, what writing for the BMJ involves, her work with the BMA and vision for general practice in the future.

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Welcome to the Hot Topics podcast from NB Medical with Dr Neal Tucker. In this episode, we look at three new papers with practice-changing consequences. 

Firstly, can treating partners of women with bacterial vaginosis prevent recurrence? Secondly, can semaglutide be effective in alcohol misuse? Finally, is tirzepatide an effective treatment for pre-diabetes in people with obesity (take a guess...!)?

References

NEJM Male partner treatment for BV

JAMA Psychiatry GLP1a & alcohol

NEJM Tirzepatide for Pre-diabetes

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Welcome to the Hot Topics podcast from NB Medical with Dr Neal Tucker. In this episode, we are joined by Dr Stephen Bradley, lead author of a new paper published in the BJGP looking at rates of CXR use in general practice and how this influences lung cancer stage at diagnosis and mortality. 

He discusses the findings of his research and how this might influence our practice. 

In other research, we look at a new paper in the BMJ on orthostatic HYPERtension - yes, you read that correctly - does treatment help, and does it really matter in the first place? And from the Lancet, research looking at the role of urodynamic studies in women with refractory overactive bladder - does it improve outcomes, or should it be stopped?

References

BMJ Orthostatic hypertension and BP treatment

BMJ OH editorial

Lancet Refractory overactive bladder & urodynamic studies

BJGP CXR in GP & lung cancer staging and mortality

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In our first Hot Topics podcast from NB Medical Dr Neal Tucker discusses why Public Health England should review its stance on e-cigarette safety, looks at Dame Sally Davies report on childhood obesity and explores general practice medical news and cutting edge medicine.

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In our second NB Podcast from NB Medical Dr Neal Tucker discusses recent Hot Topics including the restrictions on ranitidine, the benefits of taking anti-hypertensives at night-time, using statins just once a week and new technology for genome editing.

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In our latest Hot Topics Podcast, Neal Tucker is joined by Dr Simon Curtis to discuss where we are with medical cannabis, plus the latest news and research from primary care, including how to prevent catching election fever, online treatment for chronic dizziness, bempedoic acid for cholesterol reduction, lefamulin, a new antibiotic for pneumonia and the effect that measles has on the immune system.

Listen closely for details of how to enter our exclusive prize draw with a chance to win a FREE HOT TOPICS WEBINAR of your choice.

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In our latest Hot Topics Podcast, Neal Tucker reviews the latest news and research from primary care, including the benefits of dapagliflozin for heart failure, the lack of benefits of levothyroxine in subclinical hypothyroidism in the elderly, the role of melatonin in insomnia management, and suspended animation in humans.

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In this final Hot Topics Podcast before Christmas, Dr Neal Tucker explores a fascinating new piece of research showing how lipid levels at younger ages can predict future cardiovascular events and may suggest early statin therapy would be highly beneficial. He also examines the latest news and research in general practice including the best initial strategy for managing dyspepsia, how to communicate risk, and a once-monthly progesterone only capsule… in pigs…

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In this first episode for 2020, Dr Neal Tucker explores new research on alcohol abstinence in improving atrial fibrillation, and colchicine post-myocardial infarction to reduce inflammation and prevent recurrent CVD events. We also look more in depth at the role of anti-viral medication (neuraminidase inhibitors) in the management of influenza, why we don't prescribe and whether the latest research shows any benefit and, if so, in which patients.

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In this NB Hot Topics Podcast, Dr Neal Tucker takes an in depth look at coronavirus, the data that scientists need to predict whether it becomes a pandemic, and how this affects UK general practice. He also reviews new research on isolated diastolic hypertension and whether treating this improves outcomes, and on the booster theory for adult exposure to children with chickenpox. As well we look at the latest news in cluding Ian Paterson and the new GP Contract.

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This week in the NB Hot Topics podcast Dr Near Tucker looks at the latest news including propranolol overdose and assisted dying, examines the latest research from around the world on Covid-19 and from the UK on CKD screening, then explores the murky world of big data and computer-assisted medicine and how this will affect us in general practice.

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In Episode 9 of the NB Hot Topics podcast, Neal Tucker looks at the latest on coronavirus, guidance for primary care and how other countries have managed the infection. In other news he discusses the 2020 Marmot report and our patients' "Lost Decade".

In new research we examine two papers in the BMJ on the role of salt reduction in hypertension and egg consumption in cardiovascular disease, plus a BJGP paper on Rapid Diagnostic Clinics for patients with vague symptoms but possible cancer. 

Our in-depth topic this week is variation in blood test results and why we can't always believe what we see. The concept of the 'reference change value' may be the most important information we will discuss all year.

Finally Future Medicine reports on communicating with patients in persistent vegetative state via the medium of functional MRI. 

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With all the stress and uncertainty Coronavirus has placed on the world and the health service this special podcast Dr Neal Tucker looks how we as professionals and humans are coping with COVID-19, what we need to know from the rapid changes in guidance over the past few days, and where we may be going next.

In the second half we look at what the latest science tells us about Coronavirus, how it might affect our patients and what we can do to help them and ourselves.

One thing is for certain, general practice is the most adaptable branch of medicine, we have fantastic teams and camaraderie, we thrive in resource-poor settings and at managing huge uncertainty on a daily basis. We can get through this together.

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In this week's NB Hot Topics Podcast, Neal Tucker looks at what lessons we can learn in general practice to help us prepare for and fight the coronavirus pandemic.

We can learn from our international colleagues who are ahead of us on the curve, and we speak to Dr Nadege Fancy, a GP in Milan, northern Italy, about what we can expect over the next few weeks.

We share how practices are adapting to meet the needs of our patients as the pandemic escalates in the UK. 

We review what new data we know about COVID-19 and explore issues around NSAIDs, ACEi/ARBs, hydroxychloroquine and testing. 

Finally, we remind us to look after ourselves. In this marathon, we need to make time for ourselves if we are to continue to look after our patients.

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In this week's NB Hot Topics Podcast Neal Tucker looks at the latest developments in the coronavirus literature including data on hydroxychloroquine/azithromycin combination treatment, why lockdown alone is not enough and why coronavirus modelling won't help us.

Now that general practice is moving from the preparation phase to managing COVID-19 in the community, we focus on the clinical presentation of the disease in our patients and colleagues, and how our experiences show it differs from hospital data and published guidance. In light of these uncertainties, what are our options? 

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The latest NB Hot Topics podcast is the third Coronavirus Special: Saving Lives and the End of Life.

In this edition, Neal Tucker reviews what we have learned about coronavirus this week including the clinical features which you have been reporting, anosmia as a marker of COVID-19, the controversy around the Roth test and how viral load relates to the severity of disease.

In the second part, we have an in-depth look at end of life care in the community for patients with COVID-19 including helpful alternatives to syringe drivers or subcut injections.

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In this latest coronavirus special Neal Tucker discusses the latest knowledge about COVID-19 and how general practice will need to adapt to a world with persisting coronavirus.

We discuss the effects of coronavirus on black, Asian and minority ethnic populations, new understanding about the clinical features of COVID-19 especially in cardiac disease, how facemasks can help protect us by limiting the spread from others and how the infection is affecting care homes.

In our in-depth section we think about how general practice might need to adapt for a future with coronavirus, what barriers we face and how this could be an opportunity to re-design primary care for the benefit of patients and staff alike.

• COVID 19 and African Americans www.jamanetwork.com/journals/jama/fullarticle/2764789
• European Society of Cardiology Myosytis www.youtube.com/embed/3qINtzH2PfI?rel=0&autoplay=1
• BMJ Facemasks www.bmj.com/content/369/bmj.m1435 
• T Greenhalgh, J Howard www.fast.ai/2020/04/13/masks-summary/

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In our latest Hot Topics podcast Neal Tucker examines the emerging treatments for Covid-19 including remdesivir, antiplatelets, vitamin D and vaccinations. Do these provide the magic bullet we need to shut down the infection and open up the world?

He also reviews the latest research including data on asymptomatic and pre-symptomatic disease in children, important for when schools re-open, and the elderly, important for managing Covid-19 in care homes. He also looks at some emerging data on the extra-respiratory effects of the disease and how it may present in primary care.

References:

• Children and covid: www.jamanetwork.com/journals/jamapediatrics/fullarticle/2764394
• Children as vectors: www.thelancet.com/journals/laninf/article/PIIS1473-3099%2820%2930236-X/fulltext
• Risk to children BMJ Editorial: https://www.bmj.com/content/369/bmj.m1669
• Care Home Transmission NEJM: https://www.nejm.org/doi/full/10.1056/NEJMoa2008457?query=featured_home
• JAMA Homeless Shelter: https://jamanetwork.com/journals/jama/fullarticle/2765378
• Remdesivir https://www.bbc.co.uk/news/health-52478783
• Antiplatelets: https://www.sciencedirect.com/science/article/pii/S2211383520305529
• ACEi/ARB benefit: https://www.ahajournals.org/doi/10.1161/CIRCRESAHA.120.317134
• New Scientiest 4 Coronaviruses: https://www.newscientist.com/article/mg24632800-700-what-four-coronaviruses-from-history-can-tell-us-about-covid-19/

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In this latest Hot Topics Podcast, Neal Tucker reviews the latest knowledge about coronavirus and non-SARs-CoV2 research relevant to primary care.

We review new reports of Kawasaki-like disease in children with Covid-19 and the implications for children returning to school. We examine data on hydroxychloroquine and azithromycin suggesting it may kill more than it cures. And we have a think about testing and the new antibody tools.

In non-coronavirus research, we look at SGLT2i and renal disease, P2Y12 inhibitors and CVD secondary prevent, whether GPs are successful in helping patients with weight loss and gestational diabetes.

References
Kawasaki-like Disease in Children with Covid-19 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31103-X/fulltext
Hydroxychloroquine for Covid-19 https://www.bmj.com/content/369/bmj.m1361
Hydroxychloroquine + azithromycin https://jamanetwork.com/journals/jama/fullarticle/2766117
Lopinavir Ritonavir in Covid-19 https://www.nejm.org/doi/full/10.1056/NEJMoa2001282?query=featured_home
BCG vaccination and Covid rates https://jamanetwork.com/journals/jama/fullarticle/2766182?guestAccessKey=a37db46c-11e4-4243-b878-648c9bf2631a&utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_content=tfl&utm_term=051320
Interpreting Test Results https://www.bmj.com/content/369/bmj.m1808
SGLT2i and renal disease https://www.bmj.com/content/369/bmj.m1186
P2Y12 inhibitors and CVD https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30315-9/fulltext
Gestational Diabetes progression https://www.bmj.com/content/369/bmj.m1361
Paid for weight loss programme referrals from GP https://bjgp.org/content/70/694/e348

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In the latest episode of the Hot Topics Podcast, Neal Tucker discusses the latest news and research relevant to primary care.

Today we talk about race, inequalities and unconscious bias and how this affects decisions about BAME medics in the UK. We also look at a Lancet paper on hydroxychloroquine risks which has been retracted due to suspicious reporting of data, and the 'tsunami' of mental illness anticipated due to coronavirus.

In new research we discuss government recommendations on face masks for the public in light of a new systematic review published in the Lancet on reducing the spread of SARS-CoV-2, use of the NEWS score in primary care and liraglutide as a weight-loss treatment for childhood obesity.

Don't forget to join us for our free Hot Topics Mental Health and COVID-19 webinar. Sign up at:

https://bit.ly/NBMedicalCOVIDMentalHealth

Links:
BJGP Protecting Health of Doctors https://bjgp.org/content/70/695/268
Lancer Retraction of Hydroxychloroquine Paper https://www.thelancet.com/lancet/article/S0140673620313246
Lancet Prevent of spread of SARS-CoV-2 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31142-9/fulltext
RCPsych Report on mental illness and Covid 19 https://www.rcpsych.ac.uk/news-and-features/latest-news/detail/2020/05/15/psychiatrists-see-alarming-rise-in-patients-needing-urgent-and-emergency-care
MIND Coronavirus resources https://www.mind.org.uk/information-support/coronavirus/
NEJM Liraglutide in adolescents study https://www.nejm.org/doi/full/10.1056/NEJMoa1916038?query=featured_home

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In our latest Hot Topics podcast, Neal Tucker discusses the latest news and research for primary care.

This week a firm focus on coronavirus once again. We talk about antibody tests and why there seems such discrepancies between the real world results in you and I and the tests' supposed accuracy. We talk about dexamethasone and the implications for primary care. And we discuss the possibility of a 2nd wave of coronavirus, how this will our jobs in primary care and what we can do to keep ourselves happy.

References
St George's Antibody Data
Recovery Trial Dexamethasone Results
Lancet Report in Iran's 2nd wave 

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Welcome to the latest episode of the Hot Topics Podcast with Neal Tucker from NB Medical.

All about coronavirus again! The two big topics this week are immunity and the importance of T cells plus an in-depth look at post-COVID syndrome, how we can anticipate the effects on the population and the resources that can help us manage it.

We've also got research on remdesivir and more on how SARS-CoV-2 affects children, plus why COVID-19 isn't a lifestyle disease but lifestyle medicine still has a role in general practice.

References:
Moving Medicine evidence review
NHS After-care needs of inpatients recovering from COVID-19
Royal Society of Occupational Therapists Fatigue Management Guide
Homerton University Hospitals Post-COVID Patient Pack
NEJM Remdesivir RCT
NEJM Children & COVID 19 Italy Letter
JAMA Persistent Symptoms after Acute COVID

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In this final podcast for the summer Dr Neal Tucker reflects on the latest news and research in the world of general practice from the past two weeks.

As COVID cases start to rise again we look at the latest research on the transmission of COVID via schools and why we all need a change in mindset about working when ill. We consider the role of GPs in taking away a patient's car keys and giving them a bike. And we look at vaccines with positive news on COVID immunisation and the difficulties of delivering 30 million flu immunisations in the Autumn while donning and doffing PPE.

Back in September, have a good summer everyone!
Neal

Resources:
BMJ paper on physical distancing
JAMA paper on COVID and school transmission

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Welcome back to Season 2 of the Hot Topics podcast with Neal Tucker.

In this episode, we discuss THAT letter, whether we can differentiate a Covid cough from a simple URTI, how long SARS-CoV-2 antibodies actually last, plus research on SGLT2 inhibitors, gut instinct and the power of continuity in general practice.

Find us on @gphottopics, Facebook or email hottopics@nbmedical.com 

• RCPCH statements on Covid in children
• UK Study Study symptoms in children 
• JAMA Antibody durability study
• Lancet SGLT2i met-analysis
• BJGP Gut Feeling in diagnosing cancer
• BJGP Continuity and mortality
• BJGP Continuity and patient perception of GPs

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Welcome back! In this episode, Dr Neal Tucker talks about the world's biggest news story: President Trump and his treatments. Should we all be getting the same? He also looks at flu vaccinations and appraisals, and challenges the Committee of Pointless S%&t to cut the crap.

In the latest research, we look at newly published data on SGLT2 inhibitor use for heart failure and renal disease in patients without diabetes and the benefits of high intensity training for longevity.

Resources:
J o Hospital Medicine and Dexamethasone study
CEBM Review of REGN-CoV2
BJGP Editorial on Appraisals
NEJM Journal with SGLT2i data
BMJ Paper on Exercise in Older people

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Hello again! In this podcast Dr Neal Tucker is joined by Dr Philippa Davies, a GP with a special interest in dermatology, to talk about the many and varied skin presentations of COVID-19 and how we might want to carefully scrutinise the rashes we're seeing over the next few months.

To make it as interactive as possible follow along using www.covidskinsigns.com and you'll be able to see exactly what we're talking about!

Also today, comedic one-liners to lighten the mood, rates of Long Covid and who is at risk, QCOVID and the latest from the major journals from the last two weeks.

References

COVID Skin Signs website from the British Association of Dermatologists
Pre-print of Long Covid Rates
Lancet SARS-CoV-2 Antibody Rates in Dialysis Patients
JAMA Editorial on Excess Mortality Rates 2020
BMJ QCOVID Paper 

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Welcome back to the Hot Topics podcast with Neal Tucker.

Finally some hope with an imminent COVID vaccine. But how good is it really and where is the data? Meanwhile general practice has been set up as the saviour of the nation but can we really vaccinate the entire population? The Committee of Horribly Absurd Orders thinks so or is it part of their long-game to say CHAO to GPs? And also some good news that we may not have to store this new vaccine at -70oC after all...

For published research we look at SSRIs for acute COVID in the community, suspect rapid antibody tests and the harm from delayed cancer treatments.

References

NS Vaccine review and report on storage
JAMA SSRI and COVID trial
BMJ Accuracy of Rapid Antibody Tests
BMJ Mortality due to cancer treatment delay

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There's really only one topic of conversation: COVID vaccines, when will we get them, how do we give them and what's going to happen about Christmas...

In this latest episode, Neal Tucker discusses the latest on general practice's role in vaccinating the nation, mistakes in the Oxford/AstraZeneca vaccine trial, the cost of vaccines and vaccinating, and how to keep thing below minus 70 degrees.

We also have a look at some new research examining whether it really matters which blood pressure medication we give first, and two papers suggesting 100 year-olds should get statins.

References
BMJ What do we know about the covid vaccines?
BMJ 1st BP med
Lancet LDL levels and CVD risk in the elderly
Lancet Efficacy of Lipid Lowering
West Yorkshire Healthy Hearts Algorithm
BMA COVID guidance

www.nbmedical.com/podcast

Merry Christmas and a Happy New Year!

There's no time to take stock of 2020 in this latest podcast. Instead Neal Tucker talks about the latest science on the new, highly transmissible variant of SARS-CoV-2 sweeping the south of England. He also looks at the success of general practice in starting the Covid vaccinations for thousands of vulnerable patients. And research on clowns in hospitals - should we have jesters in surgeries???

See you in 2021 everyone,
Neal

References

New Scientist and Variant SARS-CoV-2
Lancet Oxford/AZ Vaccine in Elderly
BMJ Clowns in Hospitals

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Belated Happy New Year! In this new podcast, Dr Neal Tucker chats about the latest news and research in general practice.

Firstly, what do the SARS-CoV-2 variants mean for the efficacy of the vaccines and should we continue the vaccine programme? The new GP contract is out and the most controversial aspects is financial incentivisation for weight loss referrals. What works? We look at two Lancet papers. New research in the BMJ on antidepressants for back pain and OA - can this be the magic cure? And finally, research on parental burnout - feeling it during lockdown? You are not alone.

References
Vaccine and variants info
GP Contract details
Lancet Weight loss study
Lancet Metabolic Surgery study
BMJ Antidepressants for Back and OA
Parental Burnout

www.nbmedical.com/podcast

Welcome to another Hot Topics Podcast!

As we rapidly vaccinate the UK our thoughts today turn to the longer term and how environmental issues affect our patients and what practices can do about it.

Neal Tucker is joined by Terry Kemple, GP and founder of the Green Impact for Health Toolkit, to chat about how practices can make positive changes to save money, improve the health of our patients now, and help save the world in the longer term. Too much for general practice? A year ago I might have said yes, but now I think we can do anything.

We also talk about COVID  vaccine efficacy and how PCNs might help my summer holiday, plus the latest research - do BP meds cause falls (the surprise answer) and a new treatment for weight loss that actually works. If you can stomach it...

References
Green Impact for Health Toolkit
Pfizer vaccine efficacy after single dose
BMJ Antihypertensive therapy and falls
NEJM Semaglutide and weight loss

www.nbmedical.com/podcast

Welcome back to the Hot Topics Podcast.

In this episode, Neal Tucker talks about Long COVID in children, changes in violence injuries during lockdown, the prospect of a universal coronavirus vaccine, and the challenges of increasing vaccination rates in general practice.

In new research, we discuss papers from the BJGP on health inequalities, who is faring badly and how consultation length impacts on inequality. Also, novel research in the BMJ examining muscle symptoms with statins. Or not as the case may be...

References
Long COVID in children
JAMA Lockdown violence in Cardiff
BJGP Inequalities in health-related quality of life
BJGP Multimorbidity, deprivation and consultant length
BMJ Statins and muscle symptoms

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Big news in this new Hot Topics podcast as we discuss very positive data on the role of inhaled budesonide for early mild COVID in community-based patients - the STOIC trial may radically change our management of COVID but why hasn't this been a huge story and should we wait to change our practice?

Also, we look at a BMJ paper examining the risk of catching and dying from COVID if you are an adult with children at home, a Lancet paper looking at only 3 days of antibiotics for pneumonia and more data on semaglutide and it's role in weight loss and improvement in non-alcoholic steatohepatitis.

References:
STOIC website and pre-print
BMJ COVID and kids cohort study
Lancet Pneumonia trial
Lancet Semaglutide and weight loss in T2DM
NEJM Semaglutide and NASH

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The big news this week has been the risk of cerebral venous sinus thrombosis post-AZ vaccine and it's been giving us all a headache, but this has overshadowed further new data confirming benefit of inhaled corticosteroids for acute mild covid and guidance that we can offer this to older patients on a case-by-case basis.

In the latest Hot Topics podcast Neal Tucker discusses the facts, figures, management and ethics of post-AZ vaccine thrombosis, reviews the Principle trial showing we now have a viable treatment for mild covid; and data on the rate of multi-organ dysfunction and death at 4 months post-hospital discharge for covid.

References
MHRA data on AZ vaccine and thrombosis risk
CDC Data on Johnson&Johnson vaccine and thrombosis risk
CDC Data on Transmission Reduction
STOIC trial Lancet Resp
Principle trial
NHS recommendations from the Principle trial data
BMJ post-covid syndrome data
UnHerd Did I Give My Patients COVID?

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Welcome back! Neal Tucker takes you through the latest Hot Topics podcast from NB Medical.

In this edition after a "cry for help" from a UK practice written in a 16-page letter to patients we look at new research in the BJGP on remoting consulting and ask for your thoughts on the state of general practice.

Are we complicit in pathologising normal life? 8% of the population are on anti-depressants - what does new research tell us about how to withdraw them?

We also explore new research on the benefits of lowering blood pressure even when it's not low, and how to improve motor recovery after stroke.

References

Rob Walker's Blog on NB Medical
Ivy Grove Practice letter to patients
BJGP paper on remote consulting
Cochrane review on antidepressant withdrawal and blog
Lancet Paper on Blood Pressure Lowering
Lancet Paper on Vagus Nerve Stimulation after stroke

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Approach a wounded animal with caution. Someone should have told this to NHS England before they wrote THAT letter. In this podcast, in classic GP style, we reflect on how this makes us feel and come to the only obvious conclusion. (We've kept it family friendly...)

Meanwhile, Neal Tucker has a look at new research on COVID vaccinations and their efficacy against variants from around the world. New data on long covid which begs the question where is the tsunami we were expecting? Also getting to the heart of general practice, is there a role for grommets in recurrent acute otitis media? And finally what intervention has an NNT of 8 to prevent death in diabetics? Here's a clue: it isn't a medication.

References

Lancet Efficacy of Pfizer vaccine against UK variant
BMJ Efficacy of AZ/Pfizer against Indian variant
NEJM Efficacy of AZ against South African variant
BMJ Re-infections from Brazilian variant
BMJ Clinical sequalae after acute covid
NEJM Grommets or medicine for recurrent acute otitis media
Lancet Bariatric surgery long term follow up

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In this episode of the Hot Topics Podcast, Neal Tucker considers if there is a crisis of identity in GP and how the ever-increasing workload has changed the traditional role of a GP. Is there a solution? Possibly, but not everyone will agree.

In new research, we focus on new technology. Are implantable rhythm monitors helpful after stroke? Do wearable glucose monitors improve diabetes care? Is more data always better?

References:
BJGP Editorial from Euan Lawson
BJGP Editorial from Clare Gerada
BJGP Editorial on crisis of identity in GP
NICE Diagnostic Guideline Implantable Arrythmia Monitors
JAMA Implantable arrythmia monitors after stroke
JAMA continuous glucose monitoring in T2DM
Lancet continuous glucose monitoring in T1DM

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In this episode, Neal Tucker squeezes in a podcast between childcare during self-isolation. When he's let out there will be a new sort of Freedom in England, should the rest of the UK be jealous?

We think about rising covid numbers, how this impacts general practice (and the rest of the health service), and what role vaccination for children should play in this complex situation.

Also, we look at new research on evidence-based drug optimisation strategies in multimorbid and question why they don't work and whether this matters, and antispasmodics for low back pain. Most of us prescribe them, are they really helpful?

References

New Scientist Is it time for the UK to vaccination children against covid 19?
JAMA Long term Symptoms After COVID infection in children and adolescents
BMJ OPERAM study
BMJ Antispasmodics in LBP

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In this summer holidays episode of the Hot Topics Podcast, Neal Tucker looks at the latest research for the primary care community.

Firstly, three treatments for covid-19 in community-managed patients - do they work?

Next rotator cuff injury - can progressive exercise beat usual care and is there ANY role for steroid injections?

Finally, FIT testing for suspected colorectal cancer - do we now have the data to replace colonoscopy?

And as you’re here you probably like podcasts, so have a listen to Tamsin Ellis on the BBC talking about general practice and the environment. Link below. 

References

Tamsin Ellis BBC Podcast
NHS England Blood Bottle Guidance
Community Covid and Azithromycin, Doxycycline and Colchicine
Lancet Rotator Cuff Injury
BJGP letter
BJGP editorials - infection and CVD, expanding the role of GP
BJGP FIT testing

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Welcome, to Season 3 of the Hot Topics podcast with Dr Neal Tucker.

In this episode, we lament why Health Secretaries appear to hate healthcare. We also look at the rationale for covid boosters with new research on the vaccine response in the immunosuppressed and waning efficacy in the general population.

In other research, can a 4-in-1 pill be a helpful 1st line treatment for hypertension?  And should we all be prescribing medical cannabis? The BMJ says yes, but not how.

A technical issue today means the SQ is not my best (or muppet-itis), but I've figured it out for next time!

References
BMJ Report Covid Vax & Immunosuppressed
NEJM Vaccine Efficacy 6 months on
NEJM Israel & 3rd Dose Results
Lancet Quadpill & BP
BMJ Medical Cannabis

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In this latest episode of the Hot Topics podcast, Neal Tucker considers why the press have been attacking general practice and who stands to gain. We also look at new research in to giving anti-emetics for children with gastroenteritis, the accuracy of PHQ9 in the assessment of depression and what are safe levels of air pollution.

References

BMJ Air pollution
BJGP Ondansetron in children with gastro
BMJ PHQ 9 accuracy

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In this latest Hot Topics Podcast, Dr Neal Tucker reflects on the NHSE Rescue Package and asks if we are going to strike are we clear what we want general practice to be? Time for us to make up our minds.

In research we look at multimorbidity clusters and consultation rates - how should this influence funding? Also a ray of hope for patients with heart failure and preserved ejection fraction with empagliflozin - but is it as good as it appears to be? And two papers on AF screening including implanting a mini-ECG machine in your chest wall. Sounds like a lot of effort, but does it help???

References

BJGP MM & Consultation Rates
NEJM Empagliflozin & HFpEF
Lancet STROKESTOP study & ILR study

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Welcome back to another Hot Topics podcast from NB Medical with Dr Neal Tucker.

Everyone in his family has a cold - is this the anticipated surge in respiratory tract infections we've expected to see or could it have a simpler explanation?

We also look at the new draft Depression guideline from NICE, asking can we deliver the promises, long covid guidance in the knowledge we can't and new data on the effectiveness of inflatable intragastric balloon bariatric surgery.

References

RCGP Weekly RTI report
Dr Farah Jameel speech
Draft NICE Depression guideline
BJGP Long COVID guidance
Lancet Intragastric Balloon Bariatric Surgery

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Welcome everyone to the last Hot Topics podcast for 2021! 

In this episode Neal Tucker discusses the omicron variant, the cancelling of the festive season for general practice and  the effectiveness of vaccines and boosters. While it doesn't feel like there's much cheer at the moment he also reflects on our achievements this year and reasons for us to hold our heads up high.

Plus he tries to write music again - stick around to the end for the Omicron carol - it is Christmas after all. 

Merry Christmas and a Happy New Year everyone! Good luck over the next few weeks!

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Happy New Year! Welcome to a new episode of the Hot Topics podcast with Neal Tucker.

In this episode, we have a look at research that states the obvious (non-covid infections went down during lockdowns) and why we feel the need to formalise it. We also look at new research suggesting a shorter duration of anticoagulation may be appropriate after provoked VTE in younger people. We have new research showing the benefits of thrombectomy after stroke for well beyond a 6-hour window. We also have research showing which drug option may be most effective to aid weight loss.

No songs today - too busy writing the Spring Hot Topics course - but a smattering of Dad jokes. Don't say I didn't warn you...

References
BMJ Infection rates during covid measures
JAMA Duration of anticoagulation after provoked VTE in <21yo
Lancet Successful time limits for thrombectomy post-CVA
Lancet Pharmacotherapy for Obesity network meta-analysis
GP Horizon

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