Clinical Update

Asthma and COPD may be the ‘bread and butter’ of the respiratory conditions seen in primary care, but other respiratory conditions, such as bronchiectasis, will also be seen. In this episode of the MIMS Learning Clinical Update podcast, MIMS Learning editors Dawn and Pat survey the wide range of respiratory conditions seen in primary care that are not COPD or asthma. They look at the diagnosis of bronchiectasis, improvements in managing cystic fibrosis, the rising incidence of tuberculosis (TB), and how the NHS Lung Cancer Screening Programme is enabling earlier diagnosis.Educational objectivesAfter listening to this podcast, healthcare professionals should be better able to: Describe the pathophysiology of bronchiectasisReview how developments in screening and management has improved outcomes in cystic fibrosisDiscuss which socioeconomic groups are at increased risk of tuberculosisRecall the number of lung cancers detected through the NHS lung cancer screening programmeYou can access the website version of this podcast, along with a list of key learning points, on MIMS Learning - and make notes for your appraisal. MIMS Learning offers hundreds of hours of CPD for healthcare professionals, along with a handy CPD organiser.Please note: this podcast is presented by medical editors and discusses educational content written or presented by doctors, nurses and other healthcare professionals on the MIMS Learning website and at live events.MIMS LearningSubscribe to MIMS LearningBronchiectasis: clinical reviewCystic fibrosis: clinical reviewInflammatory bowel disease mimicsLung cancer: presentation and referralPodcast: advanced nurse practitioner Beverley Bostock on asthma and COPDPodcast bonus episode: Dr Steve Holmes on asthma in pregnancy and childhood wheezeMIMSEarly start to flu season prompts warning for healthcare professionalsInfluenza vaccines 2025/2026Influenza vaccines, which vaccine to offer

Pancreatic cancer is the deadliest common cancer, with more than half of people dying within three months of diagnosis and 80% of people diagnosed at a late stage.In this episode of the Clinical Update podcast, part of MIMS Learning's ‘Patient, Presentation, Pathway for Cancer’ campaign, Rhiannon speaks to Rachel Richardson, a pancreatic cancer specialist nurse at Pancreatic Cancer UK.During their discussion, they consider the common but often vague symptoms patients may experience, including abdominal/back pain, unexplained weight loss, and new-onset diabetes. Rachel says: ‘Research does highlight that over 90% of pancreatic cancer patients will actually visit their GP with relevant symptoms in the 2 years before they're diagnosed. So really this represents such a crucial window of opportunity for earlier detection.’The discussion also covers key risk factors, the important link between pancreatic cancer and type 3c diabetes, and new diagnostic tools in development – such as breath and blood tests – that could help GPs detect pancreatic cancer earlier.Educational objectivesAfter listening to this podcast, healthcare professionals should be better able to:Recall the common, but often vague symptoms, of pancreatic cancerIdentify key risk factors, including age, family history, smoking, obesity and pancreatic cystsUnderstand the link between type 3c diabetes and pancreatic cancerRecognise the challenges in diagnosis, including late presentation and non-specific symptomsDescribe promising new diagnostic tools in development, such as breath and blood testsYou can access the website version of this podcast, along with a list of key learning points, on MIMS Learning - and make notes for your appraisal.MIMS Learning offers hundreds of hours of CPD for healthcare professionals, along with a handy CPD organiser.Please note: this podcast is presented by medical editors and discusses educational content written or presented by doctors, nurses and other healthcare professionals on the MIMS Learning website and at live events.MIMS LearningSubscribe to MIMS LearningPodcast: Professor Willie Hamilton on cancer risk assessment toolsPodcast: Dr Patrick Holmes on identifying type 3c diabetes in primary carePancreatic cancer - red flag symptomsOther resourcesPancreatic Cancer UK. Health professionals page.Pancreatic Cancer UK. Family history checker

In this episode of the Clinical Update podcast, MIMS Learning medical editors Sangeeta and Dawn discuss the management of thyroid and hypertensive disorders during the antenatal period, including latest guidelines and prescribing recommendations. Educational objectivesAfter listening to this podcast, healthcare professionals should be better able to:Recall the target TSH level for women who are pregnant or trying to conceiveUnderstand the increased thyroxine demand during pregnancy and practical steps for adjusting levothyroxine doses in women with hypothyroidismIdentify and manage subclinical and overt hypothyroidism in the context of pregnancy and fertilityChoose appropriate anti-thyroid medication based on the trimester, considering the risks associated with these medicationsRecall the features of pre-eclampsia and when to referDiagnose and manage hypertensive disorders of pregnancyRecall the target blood pressure range for pregnant womenKnow which antihypertensive medications are to be avoided in pregnancy owing to teratogenicity riskYou can access the website version of this podcast, along with a list of key learning points, on MIMS Learning - and make notes for your appraisal. MIMS Learning offers hundreds of hours of CPD for healthcare professionals, along with a handy CPD organiser.Please note: this podcast is presented by medical editors and discusses educational content written or presented by doctors, nurses and other healthcare professionals on the MIMS Learning website and at live events.MIMS LearningSubscribe to MIMS LearningPractice on a page: hypertensive disorders of pregnancyUnderstanding and managing fertility and pregnancy in thyroid disease

Pat from MIMS Learning speaks to GP Dr Pipin Singh about diagnosis, management and referral in this episode of the Clinical Update podcast.Dr Pipin Singh presents a way through the diagnostic maze, emphasising the need to distinguish between acute and chronic presentations, and the importance of taking time to get to the bottom of chronic symptoms.His thorough discussion of this topic emphasises the importance of continuity of care in conducting examinations and investigations, the myriad of possible causes to consider, and how to approach lifestyle measures and prescribing medication. Educational objectivesAfter listening to this podcast, healthcare professionals should be better able to: Understand the prevalence and potential impact of lower urinary tract symptoms (LUTS)Take a history from patients presenting with LUTS, and conduct examinationsUndertake relevant investigations, using tools such as a bladder diary or the International Prostate Symptom ScoreRecall possible urological and non-urological causes including benign prostatic enlargement (BPE), detrusor overactivity, ‘ketamine bladder’, malignancy and acute infectionsRecommend lifestyle measures and initiate medication for BPE and other causesReview and follow up, referring to urology if appropriateYou can access the website version of this podcast, along with a list of key learning points, on MIMS Learning - and make notes for your appraisal. MIMS Learning offers hundreds of hours of CPD for healthcare professionals, along with a handy CPD organiser.Please note: this podcast is presented by medical editors and discusses educational content written or presented by doctors, nurses and other healthcare professionals on the MIMS Learning website and at live events.MIMS LearningSubscribe to MIMS LearningBenign prostatic hyperplasia: clinical reviewLower urinary tract symptoms in men - red flag symptomsLower urinary tract symptoms: a clue to underlying diseases

Dementia is a major challenge for the NHS, with one in six people in their eighties developing the condition. For many people, fear and stigma surrounds the condition, so the GP's role as the first port of call is crucial.In this episode of the Clinical Update podcast, MIMS Learning’s Rhiannon and Sangeeta draw on the expertise of MIMS Learning’s professional clinical writers and speakers to discuss how primary care can approach the initial assessment process, key differentials such as delirium and depression, and important modifiable risk factors, including hearing loss.This episode also covers the challenge of 'therapeutic nihilism', latest research on antipsychotic use, and practical approaches to polypharmacy in patients with cognitive impairment.Educational objectivesAfter listening to this podcast, healthcare professionals should be better able to:Describe the GP's role in the initial assessment of suspected dementia, including history taking and cognitive assessment tools.Distinguish presentations of dementia from key differentials, including delirium and depression.Recall key modifiable risk factors for dementia, such as smoking, social isolation, and unmanaged hearing loss.Understand the risks associated with antipsychotic use in people with dementia and NICE recommendations for their use.Recognise 'therapeutic nihilism' and how primary care can support patients and carers through positive language and use of social prescribing.Apply a structured approach to medication reviews for patients with dementia.PresentersRhiannon AshmanDeputy editor, MIMS LearningSangeeta KrishnanMedical editor, MIMS LearningYou can access the website version of this podcast, along with a list of key learning points, on MIMS Learning - and make notes for your appraisal. MIMS Learning offers hundreds of hours of CPD for healthcare professionals, along with a handy CPD organiser.Please note: this podcast is presented by medical editors and discusses educational content written or presented by doctors, nurses and other healthcare professionals on the MIMS Learning website and at live events.MIMS LearningSubscribe to MIMS LearningGuidance update: SIGN guidelines for support of people with dementia and their carersDelirium: clinical reviewCase series: polypharmacy in older people with mental health conditions

‘Alcohol use disorder is very, very prevalent and the harm occurs long before people have physical dependence,’ Dr Steve Brinksman says in this episode of the MIMS Learning Clinical Update podcast.He adds that if patients are concerned that they are drinking too much, they may hesitate to raise the issue with their GP because they might fear being told to stop drinking completely, and GPs may feel ‘uncomfortable’ about asking people how much they drink because alcohol misuse is ‘a common problem’ within the profession. Dr Brinksman, who worked as a GP for 30 years, says that GPs should encourage colleagues to seek help if they feel they have problems, and can encourage many patients to cut down rather than cut out alcohol completely. ‘If you are drinking 50 or 60 units a week, then you reduce your harm by cutting down even to 40 units a week,’ he explains.The episode also reviews how to assess alcohol misuse, how to advise patients to cut down, and how to support patients with severe dependence.  You can access the website version of this podcast, along with a list of key learning points, on MIMS Learning — and make notes for your appraisal. MIMS Learning offers hundreds of hours of CPD for healthcare professionals, along with a handy CPD organiser.Educational objectivesAfter listening to this podcast, healthcare professionals should be better able to: Assess alcohol misuse with a validated screening tool, and keep talking to patients about their drinking over timeSupport patients to cut down their consumption, to benefit their health and prevent them from moving on to more harmful drinkingProvide brief interventions, which have good evidence of effectiveness Understand the need for oral thiamine supplementation in people with severe alcohol dependenceDiscuss the medications used during a medically-assisted withdrawalUnderstand what steps to take if they feel a colleague has alcohol use disorderFollow safeguarding procedures if a patient or colleague poses a risk to others because of their alcohol usePlease note: this podcast is presented by medical editors and discusses educational content written or presented by doctors, nurses and other healthcare professionals on the MIMS Learning website and at live events.MIMS LearningSubscribe to MIMS LearningAbnormal liver function tests: case-based discussionFoetal alcohol spectrum disorderSmoking cessation for people with mental illnessSmoking, alcohol and psoriasisMIMSThiamine