NB Hot Topics Podcast

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The Hot Topics podcast from NB Medical brings you the latest in general practice current affairs, reviews the latest research relevant to primary care, explores interesting and important topics in-depth, and looks at cutting edge medicine.

Episode Date
S4 E2: Gestational Diabetes, CVD risk & modifiable factors; roflumilast for psoriasis; bronchodilators for non-COPD smoking symptoms
1201

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

Sep 30, 2022
S4 E1: Supplements + sweeteners aren't good for your health, autoimmune disease & CVD risk, statin & muscle pain, open source diabetes
1350

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

Sep 09, 2022
S3 E15: Gout and CV events; early identification of colorectal cancer; barriers to shared decision making in multimorbidity
1208

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

Aug 03, 2022
S3 E14: The "Sorry, I'm Not Sorry" Song; bye bye Boris; prescribing for anxiety, bariatric surgery to reduce cancer, RSV vaccine
1481

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


Jul 08, 2022
S3 E13 - "Plans for change", Panorama and Partnership; NICE Traffic Lights, internet based CBT for trauma; opioids post-surgery
1412

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?

Jun 17, 2022
S3 E12 - Monkeypox song; more about monkeypox; keeping the frail mobile; preventative medicine - what is it good for?; treating mild hypertension in pregnancy - right or wrong?
1246

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

May 25, 2022
S3 E11 - Self-monitoring BP in pregnancy, ezetimibe or PCSK9 inhibitors for CVD risk & a treatment for alopecia! Plus interview with Aarti Bansal & Veena Aggarwal on Improving Asthma Care & Sustainability in the NHS
2021

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

May 06, 2022
S3 E10 - How racism influences guidelines: interview with Dr Dipesh Gopal; does a 4th covid vax work? acute covid complication risk, breast pain & cancer, UTI & Abx, iron supplements
1477

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

Apr 08, 2022
S3 E9 - The RCGP Membership Fee Song; Working weekends; Covid in hamsters; The Triple F*** Syndrome; Child mental health; Recurrent UTIs
1300

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.

Mar 18, 2022
S3 E8: The end of covid; accuracy of lateral flow tests; new DVT algorithm; remember Zika?
1125

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

Feb 25, 2022
S3 E7 - Covid blues song; racism, nationalisation, incentivisation; new covid drugs; does continuity help?
1606

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

Feb 04, 2022
S3 E6 - Stating the obvious, treatment time after VTE and CVA; best meds for obesity
1086

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

Jan 14, 2022
S3 E5 - The Omicron song, vaccine clinics and what we've achieved this year
892

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!


Dec 16, 2021
S3 E4: The RTI surge song, NICE depression or not, Long Covid guidance, balloon bariatric surgery
1278

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

Nov 26, 2021
S3 E3 - Rescuing ourselves with a shared vision; funding GP & multimorbidity; empagliflozin for HFpEF; AF - to screen or not to screen
1216

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

Oct 22, 2021
S3 E2 - The press, corporations & conspiracies; ondansetron for kids with gastro; PHQ9, what is it good for?
924

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

Oct 07, 2021
S3 E1 - Heath secretaries, COVID boosters, Quadpill for BP & Cannabis for pain
1399

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

Sep 17, 2021
S2 E16 - Blood bottle crisis; community covid treatments; rotator cuff injury; FIT testing for cancer
961

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

Aug 11, 2021
S2 E15 - Self-isolation, Freedom and GP; Drug Optimisation for the Multimorbid; Antispasmodics for Low Back Pain
1221

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

Jul 16, 2021
S2 E14 - Crisis of identity in GP; implantable arrythmia monitors for AF; wearable glucose monitors for diabetes
1286

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

Jun 16, 2021
S2 E13 - Wounded animals
1340

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

May 26, 2021
S2 E12 - Remote consulting and the state of GP; Antidepressant withdrawal techniques; Blood pressure lowering for normotensives; Vagus nerve stimulation after stroke
1104

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

May 07, 2021
S2 E11 - Headaches, AZ and Thrombosis; Green Light for Inhaled Steroids in GP; Risk of death on discharge post-COVID
1201

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?

Apr 16, 2021
S2 E10 - Inhaled steroids for COVID in GP; risk of COVID in adults with kids; 3 days of antibiotics for pneumonia; more semaglutide stuff
1296

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

Mar 26, 2021
S2 E9 - Long COVID in kids, statins and muscle pain, health inequalities and consultation length
1309

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

Mar 05, 2021
S2 E8 - GP and the Environment - interview with Terry Kemple; BP meds & falls; Semaglutide & weight loss; a little COVID...
1469

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

Feb 12, 2021
S2 E7 - Variants and the vaccine; GP Contract, Obesity and Surgery; Anti-depressants for OA; Parental Burnout
1381

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

Jan 22, 2021
S2 E6 - Mutant covid, the success of GP and covid vaccinations, clowns in hospitals and merry Christmas!
951

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

Dec 22, 2020
S2 E5 - Covid vaccines, the story continues... & BP meds and statins for 100 year olds.
1049

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

Dec 04, 2020
S2 E4 - COVID Vaccines and missing data, PCN DES and the Committee of Horribly Absurd Orders, SSRIs for acute mild COVID, Cancer Delay and Death
1365

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

Nov 13, 2020
S2 E3 - COVID Skin Signs, Long Covid Rates, Dad Jokes
1317

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 

Oct 23, 2020
S2 E2 - Trump's Treatments, The Committee of Pointless S**t, Gliflozins for All
1284

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

Oct 09, 2020
S2 E1 - Covid symptoms in kids, antibody durability, gut instinct and the power of continuity
1188

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 

 

Sep 18, 2020
S1 E20 - Schools, Boris bikes, Obesity and Vaccines
1161

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

Jul 31, 2020
S1 E19 - Immunity and T cells, Post-COVID Syndrome
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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

Jul 10, 2020
S1 E18 - Antibody tests, dexamethasone and the coming 2nd wave
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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 

Jun 19, 2020
S1 E17 - Race, riots and inequality; faked hydroxychlorquine research; face masks; NEWS in GP; liraglutide for childhood obesity
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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



Jun 05, 2020
S1 E16 - Children, coronavirus and Kawasaki-like disease; Hydroxychloroquine, azithromycin and cardiac arrest; antibody testing; non-coronavirus research!!!
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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

May 15, 2020
S1 E15 - Coronavirus Special: Do The Drugs Work?
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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:

May 01, 2020
S1 E14 - Coronavirus Special: The Future for General Practice
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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.

Apr 17, 2020
S1 E13 - Coronavirus Special: Saving Lives and the End of Life
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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.

Apr 03, 2020
S1 E12 - Coronavirus Special: Covid-19 in the Community
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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? 

Mar 27, 2020
S1 E11 - Coronavirus Special: Lessons for General Practice
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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.

Mar 20, 2020
S1 E10 - Coronavirus Special: Making General Practice Great Again
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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.

Mar 13, 2020
S1 E9 - Coronavirus pt.3, Salt and BP, Eggs and CVD, Why All Blood Tests are Wrong
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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. 

Mar 06, 2020
S1 E8 - Coronavirus pt.2, Propranolol Overdose, CKD screening, Big Data and GP
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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.

Feb 21, 2020
S1 E7 - Coronavirus, Isolated Diastolic Hypertension & Varicella Booster
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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.

Feb 07, 2020
S1 E6 - Alcohol and AF, Colchicine and Cardiac Events, Anti-virals and Influenza
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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.

Jan 17, 2020
S1 E5 - Cholesterol Levels in Younger Age Predicting Future Risk, Dyspepsia Strategies, Once-monthly POP
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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…

Dec 13, 2019
S1 E4 - Dapagliflozin in Heart Failure, Melatonin for Insomnia, Suspended Animation
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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.


Nov 29, 2019
S1 E3 - Medical Cannabis, Vestibular Rehabiliation, Bempedoic Acid, Measles and Immunity
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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.

Nov 15, 2019
S1 E2 - Ranitidine, Night-time Anti-hypertensives, Once Weekly Statins, Genome Editing
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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.

Nov 01, 2019
S1 E1 - Childhood Obesity, eCigarettes & Exoskeletons
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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.

Oct 16, 2019