The video version of this podcast can be found here: ·      https://youtu.be/aB6Z7tASKrcThis 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.NICE stands for "National Institute for Health and Care Excellence" and is an independent organization within the UK healthcare system that produces evidence-based guidelines and recommendations to help healthcare professionals deliver the best possible care to patients, particularly within the NHS (National Health Service) by assessing new health technologies and treatments and determining their cost-effectiveness; essentially guiding best practices for patient care across the country.My name is Fernando Florido and I am a General Practitioner in the United Kingdom. In this episode I go through new and updated recommendations published in April  2025 by the National Institute for Health and Care Excellence (NICE), focusing on those 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.   Disclaimer:The Video Content on this channel is for educational purposes and not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read or seen on this YouTube channel. The statements made throughout this video are not to be used or relied on to diagnose, treat, cure or prevent health conditions. In addition, transmission of this Content is not intended to create, and receipt by you does not constitute, a physician-patient relationship with Dr Fernando Florido, his employees, agents, independent contractors, or anyone acting on behalf of Dr Fernando Florido. Intro / 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  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 Full NICE News bulletin for April 2025 can be found here: ·      https://www.nice.org.uk/guidance/published?from=2025-04-01&to=2025-04-30&ndt=Guidance&ndt=Quality+standard The links to the guidance covered in this episode can be found here: The NICE guideline on Falls: assessment and prevention in older people and in people 50 and over at higher risk [NG249] can be found here: ·      https://www.nice.org.uk/guidance/ng249 The update on Suspected cancer: recognition and referral [NG12] can be found here: ·      https://www.nice.org.uk/guidance/ng12·      https://www.nice.org.uk/guidance/ng12/chapter/Recommendations-organised-by-site-of-cancer#myeloma 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’m Fernando, a GP in the UK. In today’s episode, we’ll be looking at the NICE updates published in April 2025, focusing on what is relevant to Primary Care only.We’ve got another short and snappy episode today, as there are only two clinical areas to discuss: the brand-new national guideline on fall prevention and new advice on cancer recognition and early detection.Right, let’s jump into it.And let us start with the update on the cancer recognition guideline, which affects the recommendations on blood tests for myeloma. These recommendations have been amended in response to a series of reviews to improve earlier diagnosis. So now those with an unexplained fracture or persistent bone pain, particularly back pain, and especially if they are aged 60 or over, should be investigated for myeloma, although we can consider it for people under 60 too. For this assessment we will request the following blood tests:a full blood count serum calciumeither plasma viscosity or ESRparaprotein, using serum protein electrophoresis andSerum free light chains. If the serum test is not available, we can use a Bence–Jones test to check for free light chains in the urine. The change means that we should now include serum protein electrophoresis and serum free light chain testing in the initial diagnostic blood tests and this testing should be offered instead of the traditional urine test for Bence–Jones protein. The second section refers to a brand-new guideline on falls assessment and prevention. These recommendations are for people who are:aged 65 or over oraged 50 to 64 with 1 or more factors that could increase their risk of falls. These factors include long-term conditions such as arthritis, dementia, diabetes or Parkinson's disease, having had a stroke and having a learning disability.The guideline recommends a comprehensive assessment and management plan for these patients. But, who should we prioritise?Well, we should offer comprehensive falls assessment and management to people who have fallen in the last year and who:Are frail.Were injured in a fall.Have experienced a loss of consciousness related to a fall.Have been unable to get up independently after a fall or thatHave had 2 or more falls in the last year.For people who have fallen in the last year and who do not have any of these criteria we should assess their gait and balance And if they have a gait or balance impairment:We will simply offer a falls prevention exercise programme anda home hazard assessment.But let’s go back to the people in the first group, those at highest risk and the ones that need a Comprehensive falls assessment. What should this assessment include? Well, we should check for:Alcohol misuse.Perform a Neurological and Cardiovascular examination including a lying and standing BP.We will do an Osteoporosis risk assessment including the risk of fragility fractures.A review of medication and long-term medical conditions and also includeAn overall review of the patient looking at things like:Cognition and mood.Diet, and weight loss.Hearing and visual impairments.Dizziness.Functional ability.Urinary continenceGait, balance, mobility, etc And once we have done this assessment, what does the comprehensive falls management entail? Well, apart from addressing obvious issues identified in the assessment, this management plan should include: 1- A structured medication review and, for those on psychotropic drugs, we will discuss their increased risk of falls, considering stopping these medications, liaising with specialist services if necessary. Psychotropic medicines include antipsychotics, antidepressants, anxiolytics, mood stabilising agents, and antiepileptic drugs2- we will refer to occupational therapy and any other appropriate service for a home hazard assessment and a fall prevention exercise programme 3- We will consider the need for surgical interventions, such as cataract surgery or a pacemaker, if these problems have played a role in their falls, and finally, 2- Although there is insufficient evidence to support taking vitamin D supplements specifically to lower the risk of falls, we will encourage people to follow NHS advice on taking vitamin D to maintain bone and muscle health. For adults and children over 4 years old this advice is that they should consider taking a daily supplement containing 10 micrograms or 400 IU of vitamin D during the autumn and winter months, generally from early October to the end of March, and this includes pregnant and breastfeeding women. Between early April to the end of September, most people can make all the vitamin D they need through sunlight and from a balanced diet, so they may choose not to take a vitamin D supplement during these months. However, people at risk of vitamin D deficiency, including the frail and the housebound and also those with darker skin, for example those of African, African-Caribbean or south Asian background should take 10 micrograms or 400 IU of vitamin D throughout the year. The advice for infants and children under 4 is slightly different and it is not covered here.So that is it, a review of the NICE updates relevant to primary care.We have come to the end of this episode. Remember that this is not medical advice but 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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