Clinical Update

‘Resistant hypertension is when you’re taking three or more medications and you’ve not reached target, and usually one of those medications is a diuretic,’ Professor Terry McCormack explains in this episode of the Clinical Update podcast. He adds that determining whether patients are truly resistant or just not taking their medication can be difficult. However, he recommends asking subtle questions such as ‘We all forget to take our tablets. How, how often do you forget to take your medication’ to gain meaningful answers.Professor McCormack also looks at management options — including combination pills, NICE-recommended therapies, and new treatments that are on the horizon. He observes that patients with resistant hypertension are the ‘highest risk patients’ for adverse outcomes such as stroke and, therefore, ‘we need to try our best to get them to take at least the three medications that are available to us at this time, to consider single pill combinations and, in the future, consider other treatments,’.Educational objectivesAfter listening to this podcast, healthcare professionals should be better able to:Sensitively ask patients about their adherence to antihypertensive medicationsEncourage patients to adhere to medications regimens by discussing of risks of not taking their medications (such as a debilitating stroke)Understand the pros and cons of single-pill combination therapy for managing hypertensionReview NICE recommendations on managing resistant hypertensionDiscuss new treatments on the horizon for managing resistant hypertensionYou can access the website version of this podcast, along with key learning points, on MIMS Learning. MIMS Learning offers hundreds of hours of CPD for healthcare professionals, along with a handy CPD organiser and note-taking for appraisal.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 LearningGuidance update: NICE guidelines on hypertensionIschaemic heart disease: clinical reviewStroke: clinical review

0.5 CPD hoursIf you enjoy a blend of online learning and podcast-style listening that you can fit into your busy life, then this podcourse is for you. Listen to this three-part audio series, then go to mimslearning.co.uk to read downloadable worksheets and complete a multiple choice quiz to ensure you are up to speed with all the key points primary care professionals need to know about migraine. This episode continues the case of Simone, focusing on her children, with learning points provided by GP Dr Deborah Kerr. She provides advice on recognising migraine in children, eliminating red flags, addressing lifestyle and routine, and pharmacological therapy for acute management and prevention.MIMS Learning offers hundreds of hours of CPD for healthcare professionals, along with a handy CPD organiser. Educational objectivesAfter listening to this podcourse, healthcare professionals should be better able to:Recall the characteristics of migraine and abdominal migraine in children and adolescentsReflect on red flag symptoms and differentials to consider Provide advice on lifestyle and use of supplements Advise on pharmacological options for acute attacks and prophylaxisBe aware of links between neurodiversity and migraineKnow where to find more information about prescribing and supportMIMS LearningMigraine podcourse with Dr Deborah Kerr, part 1: diagnosis and managementMigraine podcourse with Dr Deborah Kerr, part 2: menstrual-related migraineGuidance update: NICE and SIGN guidelines on headacheHeadache - red flag symptomsHeadaches in children - red flag symptoms

0.5 CPD hoursIf you enjoy a blend of online learning and podcast-style listening that you can fit into your busy life, then this podcourse is for you. Listen to this three-part audio series, then go to mimslearning.co.uk to read downloadable worksheets and complete a multiple choice quiz to ensure you are up to speed with all the key points primary care professionals need to know about migraine. This episode continues the case of Simone, with learning points provided by GP Dr Deborah Kerr. She provides advice on the definitions of menstrual and menstrual-related migraine, tips on lifestyle and pharmacological management, pregnancy planning and looking ahead to menopause management. MIMS Learning offers hundreds of hours of CPD for healthcare professionals, along with a handy CPD organiser. Educational objectivesAfter listening to this podcourse, healthcare professionals should be better able to:Recall the characteristics of menstrual migraine and menstrual-related migraineProvide advice on lifestyle and use of supplements Understand how hormones such as the contraceptive pill may be used in patients wit migraineKnow which medications could be used to try and prevent menstrual-related attacksProvide advice to women planning a pregnancy, and those who are breastfeedingRecall treatment options for acute management and preventative therapyUnderstand when to refer patients to specialist careMIMS LearningMigraine podcourse with Dr Deborah Kerr, part 1: diagnosis and managementMigraine podcourse with Dr Deborah Kerr, part 3: migraine in childrenGuidance update: NICE and SIGN guidelines on headacheHeadache - red flag symptomsHeadaches in children - red flag symptoms

0.5 CPD hoursIf you enjoy a blend of online learning and podcast-style listening that you can fit into your busy life, then this podcourse is for you. Listen to this three-part audio series, then go to mimslearning.co.uk to read downloadable worksheets and complete a multiple choice quiz to ensure you are up to speed with all the key points primary care professionals need to know about migraine. In this episode, work through the case of Simone, with learning points provided by GP Dr Deborah Kerr. She provides practical advice to give patients on managing attacks, and tips on lifestyle and pharmacological management – including newer medications.MIMS Learning offers hundreds of hours of CPD for healthcare professionals, along with a handy CPD organiser. Educational objectivesAfter listening to this podcourse episode, healthcare professionals should be better able to:Recall the characteristics of migraine and distinguish between chronic and episodic migraineUnderstand how migraine differs from medication overuse headache, trigeminal autonomic cephalalgia, and idiopathic intracranial hypertensionUnderstand the importance of examination to eliminate red flagsUnderstand how lifestyle affects migraine and provide advice to patientsKnow which medications should be avoided and what patients should do at the first sign of an attackRecall treatment options for acute management and preventative therapyUnderstand when to refer patients to specialist careMIMS LearningMigraine podcourse with Dr Deborah Kerr, part 2: menstrual-related migraineMigraine podcourse with Dr Deborah Kerr, part 3: migraine in childrenGuidance update: NICE and SIGN guidelines on headacheHeadache - red flag symptomsHeadaches in children - red flag symptoms

0.5 CPD hoursA GP partner is juggling her work and parenting responsibilities - as well as arranging care for her ageing mother - and feels ‘like she is missing symptoms’. A locum GP has back pain, but fears that his relationship with those he works for might be jeopardised if he asks for suitable adaptations. A salaried GP is experiencing mental health problems, but fears that disclosure might mean she ‘loses her role’.Experienced GP appraiser Dr Ravi Ramanathan discusses each of these scenarios with MIMS Learning editor Pat Anderson, and recommends action that the GPs concerned could take, to look after themselves and to avoid burnout.Educational objectivesAfter listening to this podcast, healthcare professionals should be better able to:Understand the role of appraisal in providing support for professional and personal life pressuresAppreciate the importance of clear communication with colleagues to resolve issues that could lead to burnoutReflect on the importance of disclosure of stress-related or mental health problems to their appraiserUnderstand how acknowledging problems and seeking help are positive steps that can help GPs to continue to practise successfullyRecall sources of support that may be useful to them or their colleaguesIf you are affected by issues discussed in this podcast, remember that support is available to all doctors through the BMA Your Wellbeing service, NHS Practitioner Health and The Cameron Fund.You can access the website version of this podcast, along with key learning points, on MIMS Learning. MIMS Learning offers hundreds of hours of CPD for healthcare professionals, along with a handy CPD organiser and note-taking for appraisal.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.ResourcesMIMS LearningPodcast: pursuing a GP career after addiction recovery, with Dr Michael BlackmorePodcast: Dr Farnaaz Sharief on finding balance in a pressured systemWellbeing masterclassPodcast: Dr Ravi Ramanathan on changes to GP appraisal

0.5 CPD hoursThis discussion on obesity and its management, hosted by MIMS Learning editor Pat Anderson, took place at MIMS Learning Live South in London. Former GP Dr Patrick Holmes and consultant diabetologist Dr Amar Puttanna are part of the education provider Goggledocs and provided key learning points for GPs during the discussion.Educational objectivesAfter listening to this podcast, GPs and other healthcare professionals should be better able to:Recall key facts about the impact of obesity in the UKUnderstand how public health measures do (or don’t) workReflect on the importance of the GP’s role in obesity managementBe aware of how weight loss therapies fit into the obesity pictureConsider the effectiveness of new and future therapies Improve the management of obesity within their practiceYou can access the website version of this podcast, along with key learning points, on MIMS Learning. MIMS Learning offers hundreds of hours of CPD for healthcare professionals, along with a handy CPD organiser and note-taking for appraisal.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 LearningRegister for a FREE accountGuidance update: latest NICE guidelines on type 2 diabetes in adultsObesity podcourse with Dr Patrick Holmes, part 1: metabolic vulnerabilitySimplifying primary care management of obesity

Lord Heseltine tells the story of the birth of the European Space Agency. Why post-Apollo, when the US was spending £1.2 billion a year on space, the whole of Europe was spending just £200 million. Why the birth of ESA was driven by the self-interest of three major countries. Why the US general with a $29 billion budget for the Star Wars project wanted to invest in Heriot-Watt University in Edinburgh. Why, the idea that Britain could compete alone with the technologies that were accumulated and available to the American capitalist system was “simply laughable”. Why “being European is not selling out British interests”. And why Margaret Thatcher told him: “If you want to get on and put your budget into this, you can, but you're not getting any of mine." Join Alice and Lord Heseltine as they pick apart the negotiating contrivances and the wheeling and dealing to circumnavigate “turkeys not voting for Christmas” that ultimately put European space on the map.Contributors:Alice Bunn, President of UKspace Dr Alice Bunn OBE FIMechE FRAeS CEng | LinkedInUKspace: Overview | LinkedIn Lord Heseltine, Member of the House of LordsKey topics covered:Creation of the European Space Agency (ESA)US "Star Wars" program and brain drainGeopolitical case for European R&D collaborationImpact of Brexit on science and technology

GPs and other doctors are at risk of developing abnormal coping mechanisms including addiction, but can turn things around if they spot the signs and take action, according to GP Dr Michael Blackmore. As a recovering addict, he gives advice to patients and to other GPs about how admitting problems and seeking help and support are vital, and can enable doctors to reconnect with their practice as well as their personal life.Educational objectivesAfter listening to this podcast, GPs and other healthcare professionals should be better able to:Consider why doctors are particularly at risk of abnormal coping mechanismsSpot the signs of addiction including overprescription of medicationBe aware of sources of support for doctors affected by addictionUnderstand the role of self-referral to the GMCIdentify gaps in their knowledge of drug addiction Reflect on the potential for overcoming addiction and continuing to pursue a medical careerIf you are affected by issues discussed in this podcast, remember that support is available to all doctors through the Sick Doctors Trust, the British Doctors & Dentists Group and the Practitioner Health programme.You can access the website version of this podcast, along with key learning points, on MIMS Learning. MIMS Learning offers hundreds of hours of CPD for healthcare professionals, along with a handy CPD organiser and note-taking for appraisal.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 LearningRegister for a FREE accountWellbeing masterclassPodcast: Dr Farnaaz Sharief on finding balance in a pressured systemHarnessing conflict for growth: strategies for healthcare teams

Bloating is a common presentation in primary care and can be caused by a wide variety of conditions, including irritable bowel syndrome, food intolerances, and small intestinal bacterial overgrowth.[Main] Bloating is a key characteristic of irritable bowel syndrome (IBS), but can also be a sign of a food intolerance (such as lactose intolerance) and small intestinal bacterial overgrowth (SIBO). In this episode of the Clinical Update podcast, MIMS Learning editors Sangeeta and Rhiannon explore the potential causes of bloating and how they should be diagnosed and managed.They review both the NICE and the Rome IV criteria for diagnosing IBS, subtypes, and management options (such as the FODMAP diet), and look at red flag symptoms that require further assessment.  They also discuss the differences between functional gastrointestinal conditions and IBS.The bidirectional relationship between eating disorders and gastrointestinal conditions, and how bile acid malabsorption can masquerade as IBS-D, are also explored.Educational objectivesAfter listening to this episode, healthcare professionals should be more aware ofHow IBS is diagnosed and managedHow functional gastrointestinal disorders differ from IBSFood intolerances (including lactose intolerance) that are associated with bloatingThe bidirectional relationship between eating disorders and gastrointestinal conditionsYou 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.This episode was produced by Jude Owen.MIMS LearningRegister for a FREE accountBloatingConstipation: red flags and new dietary guidelinesDisorders of gut-brain interactionIrritable bowel syndrome: clinical reviewMIMS Learning Live SouthBook for free