The video version of this podcast can be found here: ·      https://youtu.be/5aV0krXAuj8This episode makes reference to guidelines produced by the "National Institute for Health and Care Excellence" in the UK, also referred to as "NICE". The content on this channel reflects my professional interpretation/summary of the guidance and I am in no way affiliated with, employed by or funded/sponsored by NICE.My name is Fernando Florido and I am a General Practitioner in the United Kingdom. In this episode I will go through new and updated guidelines published in June 2024 by the National Institute for Health and Care Excellence (NICE), focusing on those that are relevant to Primary Care only. Because there were no updates relevant to Primary Care, instead in this episode I will go through the current four consultations open by NICE, also focusing on aspects that are relevant to Primary Care only. I am not giving medical advice; this video is intended for health care professionals, it is only my summary and my interpretation of the guidelines and you must use your clinical judgement.   There is a podcast version of this and other videos that you can access here: Primary Care guidelines podcast:  ·      Redcircle: https://redcircle.com/shows/primary-care-guidelines·      Spotify: https://open.spotify.com/show/5BmqS0Ol16oQ7Kr1WYzupK·      Apple podcasts: https://podcasts.apple.com/gb/podcast/primary-care-guidelines/id1608821148 There is a YouTube version of this and other videos that you can access here: The Practical GP YouTube Channel: https://youtube.com/@practicalgp?si=ecJGF5QCuMLQ6hrk The YouTube video on the management of headaches can be found here:·      https://youtu.be/6AZttMzfFr0?si=yxPcoC4legE8zS_pThe Full NICE News bulletin for June 2024 can be found here:·      https://www.nice.org.uk/guidance/published?from=2024-06-01&to=2024-06-30&ndt=Guidance&ndt=Quality+standardThe links to the current consultations can be found here:Digital supported self-management technologies for adults with chronic obstructive pulmonary disease: early value assessment:·      https://nice.us8.list-manage.com/track/click?u=7864f766b10b8edd18f19aa56&id=9f762dc422&e=03ed9b0dd012 SQ-HDM SLIT for treating allergic rhinitis and allergic asthma caused by house dust mites:·      https://nice.us8.list-manage.com/track/click?u=7864f766b10b8edd18f19aa56&id=501af7f75a&e=03ed9b0dd0Meningitis (bacterial) and meningococcal disease update:·      https://nice.us8.list-manage.com/track/click?u=7864f766b10b8edd18f19aa56&id=4baddb7b5d&e=03ed9b0dd0Asthma: diagnosis, monitoring and chronic asthma management:·      https://nice.us8.list-manage.com/track/click?u=7864f766b10b8edd18f19aa56&id=d7e86c9fd8&e=03ed9b0dd0Intro / outro music: Track: Halfway Through — Broke In Summer [Audio Library Release] Music provided by Audio Library Plus Watch: https://youtu.be/aBGk6aJM3IU Free Download / Stream: https://alplus.io/halfway-through  TranscriptIf you are listening to this podcast on YouTube, for a better experience, switch to the video version. The link is in the top right corner of the video and in the episode description.Hello and welcome, I am Fernando, a GP in the UK. Today, we were supposed to look at the NICE updates relevant to Primary Care published in June 2024. However, this month we have had no new guidance relevant to primary care, as they were all connected to secondary care such as surgical techniques, chemotherapy agents, and acute myeloid leukaemia, amongst others.So, instead, we are going to look forward and review the guidelines that are under consultation, which will lead to new or updated guidance in the coming months. Because they are in draft form, we will only give them a quick overview. They are only four areas, so today will be a brief episode. So, let’s jump into it.The first consultation is on House Dust Mite Sublingual Immunotherapy, for treating allergic rhinitis and allergic asthma caused by house dust mites. This is referred to by NICE as 12 SQ HDM SLIT, which is a tablet, also known as Acarizax, which has already been authorised by European regulatory authorities. Let’s have a look at some key points:It is recommended for:HDM-Induced Allergic Asthma that is not well-controlled by inhaled steroids andMild to severe HDM Allergic Rhinitis but it’s onlyApproved for adults aged 18 to 65 years of ageFrom a patient perspective these conditions can be debilitating, and they have an impact on daily life. Although there are other treatments available, their management can be challenging when triggers are unexpected or outside people’s control.HDM SLIT (House Dust Mite Sublingual Immunotherapy) involves the administration of allergens (in this case, house dust mites) under the tongue to desensitise the immune system to these allergens, reducing symptoms over time.It is done using a sublingual tablet that dissolves under the tongue. The goal is to gradually train the immune system to tolerate the allergen through desensitisation or tolerance induction. The treatment typically lasts several months to a few years, depending on the patient's response and the specific protocol being followed.Over time, patients usually experience a reduction in symptoms and long-lasting relief, even after the treatment has ended.It is generally considered safe, with the most common side effects being oral itching or discomfort. Serious allergic reactions are rare but can occur, so initial close medical monitoring is recommended.The effectiveness can vary depending on the person and it is an alternative to subcutaneous immunotherapy. The sublingual route is preferred because of convenience and a better safety profile due to lower risk of severe allergic reactions.The next consultation is on new quality statements on bacterial meningitis and meningococcal disease. The statements that we should be aware of in Primary care are that people who have had bacterial meningitis or meningococcal disease should have:·      An audiological assessment within 4 weeks of them being well enough for testing and·      A follow-up appointment in secondary care within 6 weeks of discharge from hospital. In the third consultation NICE evaluates various digital self-management technologies for adults with COPD. These technologies aim to support patients in managing their condition at home, potentially reducing symptoms and improving patient outcomes. Some of the key technologies being assessed include digital platforms that offer:·      Pulmonary rehabilitation·      Remote monitoring·      Weekly check-ins from healthcare professionals·      Educational modules on exercises and medication and ·      Mindfulness exercisesNICE states that, although a digital technology will not replace face-to-face appointments, offering digital technologies as an option could improve access and reduce symptoms and exacerbations. Furthermore, there have been no safety concerns for this type of supported self-management. And the final consultation is a very important one for us, because it is an update on asthma.The draft guideline on the diagnosis, monitoring, and management of chronic asthma has been produced collaboratively by the British Thoracic Society, NICE, and the Scottish Intercollegiate Guidelines Network or SIGN. It will update the previous 2017 NICE guideline and 2019 BTS/SIGN guideline. It will not cover the management of acute asthma.The update reviews questions like, for example, whether spirometry with bronchodilator reversibility should be routinely used in the diagnosis of asthma or whether the bronchodilator response (using peak flow or FEV1) should be calculated as a percentage change from the baseline result, as it is now, or change it to being related to the predicted FEV1The draft document is large so I will not be able to summarise it here. Besides, it will be better to wait for the final guidance just in case the recommendations change at the last minute. But at least it gives us some awareness of what it is to come on that front.We have come to the end of this episode. Remember that this is not medical advice and it is only my summary and my interpretation of the guidelines. You must always use your clinical judgement. Thank you for listening and goodbye.

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