Clinical Update

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

In this episode of the Clinical Update podcast, MIMS Learning deputy editor Rhiannon and medical editor Dawn provide a comprehensive update on prostate health. High-profile figures, such as Sir Chris Hoy, opening up about their own diagnoses have significantly increased public awareness of prostate cancer. In light of this, the editors discuss the rationale for targeted prostate cancer screening and patient counselling around prostate-specific antigen (PSA) tests. The conversation also highlights health inequalities in prostate cancer diagnosis, noting that Black men have double the risk of prostate cancer compared with other groups, and highlighting care for trans women, who may remain at risk of prostate cancer after gender-confirming surgery.Beyond malignancy, this episode covers the symptoms and management of benign prostatic hyperplasia (BPH) and chronic prostatitis in primary care.Educational objectivesAfter listening to this podcast, healthcare professionals should be better able to:Recall draft recommendations for targeted prostate cancer screening in high-risk groupsIdentify key risk factors for prostate cancer, including ethnicity and ageOutline factors that can raise or suppress PSA levelsUnderstand the diagnostic pathway and the role of digital rectal examinationRecognise symptoms and potential complications of BPH and prostatitisYou 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 accountExpert perspective: prostate cancer diagnosisGuidance update: NICE guidelines on prostate cancerLatest updates in prostate cancer for primary careBenign prostatic hyperplasia: clinical reviewProstate Cancer UK

In this episode of the Clinical Update podcast, Dr Louise Warburton talks to Dawn Liz Powell about the effect that obesity can have on the musculoskeletal system. She explains that if adults carry excess weight for a long time, perhaps from young adulthood, this can put additional strain on weight-bearing joints and can lead to premature wear and tear — meaning that the joints may need to be repaired or replaced.Dr Warburton, who is a GP with an extended role in musculoskeletal conditions, also talks about the importance of physical activity during childhood for developing healthy bone mass, how to sensitively raise the issue of weight loss with a person with suspected obesity-related joint pain, and how to support people with joint pain to exercise safely. The need for strength training for people on weight loss medications is also discussed during this episode.Educational objectivesAfter listening to this podcast, healthcare professionals should be better able to:Discuss the effect of childhood obesity on spinal developmentSensitively raise the issue of weight loss with a person with suspected obesity-related joint painReflect on the effect of GLP-1 medications on the musculoskeletal systemReview the risks of toxicity reactions to pain medications in people living with obesitySupport people with joint pain to exercise safelyUnderstand the importance of strength training for people on weight loss medicationsYou 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 LearningRegister for a FREE accountBone pain - red flag symptomsObesity in adultsPodcast: musculoskeletal disordersMIMS Healthcare NetworkMIMS table on obesity treatmentsMIMS Learning Live South (12 June, London, UK)

In this episode of the Clinical Update podcast, MIMS Learning editors Pat and Sangeeta discuss falls in older people, highlighting tips on assessment, the benefits of exercise, and the role of deprescribing in primary care.Falls among older people cost the UK health and care system an estimated £4.4bn annually. Drawing on insights from consultant geriatrician Dr Anna Steel and NICE and British Geriatrics Society (BGS) guidance, Pat and Sangeeta cover multifactorial risk assessments and the ‘exercise as a drug’ approach.The editors highlight the critical importance of medication reviews, particularly focusing on ‘FRIDs’ (falls risk-increasing drugs). As Dr Steel notes, patients often value their immediate quality of life and mobility over long-term cardiovascular protection, making shared decision-making essential. The episode also details pragmatic prescribing targets for blood pressure and diabetes in frail patients to minimise harm.Educational objectivesAfter listening to this podcast, healthcare professionals should be better able to:Understand the significant economic and personal impact of falls in the UKIdentify the ‘exercise as a drug’ approach to improve muscle mass and balanceConsult NICE guidance for recommendations on assessment and deprescribing Recognise fall-risk increasing drugs (FRIDs) and deprescribing tools to useUnderstand pragmatic clinical targets for blood pressure and glucose in frail patientsYou 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 Learning Register for FREEFrailty: clinical reviewHeart failure and frailtyA practical guide to conducting a structured medication reviewRecurrent falls in older people

In this episode of the Clinical Update podcast, consultant dermatologist Dr Claire Fuller talks to MIMS Learning deputy editor Rhiannon about the clinical signs of scabies – including how presentation can differ in children and older adults – and provides a detailed breakdown of effective treatment regimens for both permethrin and ivermectin.Dr Fuller goes on to discuss the issues of ‘pseudo-resistance’ and contact tracing, noting that ‘people do self-stigmatise and they really are challenged in persuading their contacts to treat.’ She also highlights scabies as a neglected tropical disease and a public health priority, with a particular focus on how it affects marginalised groups and those living in overcrowded settings.Educational objectivesAfter listening to this podcast, healthcare professionals should be better able to:Recall the clinical features of scabies in different patient groupsUnderstand the role of microscopy or dermatoscopy in diagnosisDescribe the correct treatment protocols for permethrin and ivermectinExplain the importance of treating all close contacts to prevent re-infestationRecognise the signs of crusted scabiesReflect on the wider impact of scabies, including its effect on mental healthYou 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 LearningRegister for a FREE accountRelated resources Podcast: sexual health in womenCase study: leptospirosisMpox: clinical diagnosis and managementMIMS: Lice and scabies treatmentsMIMS: Scabies medication shortages continue

GPs and primary care clinicians often encounter oral and dental problems, many of which are significant indicators of underlying systemic disease. In this episode of the Clinical Update podcast, medical editors Sangeeta and Dawn discuss symptoms and signs that can suggest gastrointestinal diseases such as Crohn’s, gastro-oesophageal reflux disease or eating disorders. They also examine the two-way relationship between periodontal health and diabetes, and the critical impact of oral health on pregnancy outcomes, including risks of pre-eclampsia and preterm birth.The episode further covers autoimmune presentations like lupus and pemphigus vulgaris, medication-related hyperpigmentation, and the oral health inequalities faced by patients with severe mental illness. Finally, the team provides practical guidance on managing maxillofacial emergencies, such as tooth avulsion and dental abscesses, in the GP surgery.Educational objectivesAfter listening to this podcast, healthcare professionals should be better able to:Recognise oral manifestations of systemic conditions including IBD, diabetes, and autoimmune diseasesUnderstand the link between periodontal disease and adverse pregnancy outcomesIdentify dental emergencies, such as tooth avulsion, and initiate time-sensitive managementRecall the red flags for dental abscesses and oral squamous cell carcinoma that warrant urgent referralAddress oral health inequalities in patients with severe mental illnessYou 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 LearningRegister for a FREE accountRelated resourcesOral signs and symptoms of systemic disease Urgent oral and dental problems Smoking cessation for people with severe mental illness

Different pollens can trigger hayfever at different times of the year and, potentially, if they are sensitive to all these different pollens, patients could be symptomatic from early January until October. Honorary consultant physician Dr Glenis Scadding advises that patients should start taking hayfever medication before their symptoms start and only stop taking it when their symptoms are likely to go away. In this episode of the medical update podcast, Dr Scadding speaks to MIMS Learning’s medical editor Sangeeta about hayfever management. She discusses what sets allergic rhinitis apart from viral infections, how to identify red flags, and what type of antihistamine to choose. She also highlights the benefits of combined intranasal sprays and the potential for sublingual immunotherapy to alter the long-term ‘allergic career’ of allergic rhinitis.Educational objectivesAfter listening to this podcast, healthcare professionals should be better able to: Recall the common red flags that necessitate urgent ENT or specialist referralIdentify the clinical differences between viral upper respiratory infections and allergic rhinitisExplain the correct technique to use intranasal corticosteroid sprays for maximum efficacyRecognise when to consider allergen-specific immunotherapy for moderate to severe hayfeverReview the relationship between poorly controlled allergic rhinitis and asthma exacerbationsYou 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 Learning resourcesRegister for a FREE accountHayfever: clinical reviewPodcast: nose problems in primary careMIMSHayfever treatments

The perinatal period — from the start of pregnancy until the baby's first birthday — is a time of significant change for women and, while much of this can be positive, for some, it brings major challenges. Mental health disorders, including anxiety, depression, OCD and PTSD, can have significant and long-lasting effects on both mothers and children. But, in this episode of the Clinical Update podcast, MIMS Learning editors Rhiannon and Pat remind us of the positive impact that primary care can have in identifying at-risk women and offering prompt intervention or referral.  They explore the biopsychosocial factors that contribute to risk of perinatal mental health disorders, including the impact of previous pregnancy loss, health inequalities, and complex social factors, and provide practical advice from experts on distinguishing postnatal depression from ‘baby blues’.Content warning: This podcast contains a brief mentions of maternal suicide, domestic violence and birth trauma, but focuses more broadly on how GPs can help patients experiencing mental health disorders. The Samaritans helpline is 116 123.Educational objectivesAfter listening to this podcast, healthcare professionals should be better able to:Apply the biopsychosocial model to identify biological, psychological, and social risk factors for perinatal mental health disordersUse screening tools such as the Whooley questions, PHQ-9, and GAD-2 to assess for depression and anxietyBe aware of red flags that may indicate a psychiatric emergency, such as postpartum psychosis, requiring immediate referralRecognise the signs of perinatal OCD, and understand how these differ from postnatal depressionDiscuss management options, including the risk-benefit profile of prescribing while breastfeeding Recall the prevalence of birth trauma and the importance of providing trauma-informed careYou 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.Useful resourcesManaging perinatal mental health disorders in primary careA guide to providing trauma-informed maternity carePodcast: navigating medication safety in breastfeeding with Rachel PilgrimEquity in maternity care - lessons from MBRRACE-UKRegister for a FREE accountMIMSAntidepressants, a guide to switching and withdrawingTreatment options in pregnancy