cardiology

Doctors Lisa and Sara talk to Senior Pharmacist Sarah Hafeez about Polypharmacy. She explains the difference between inappropriate and appropriate polypharmacy before talking through some typical cases that illustrate several examples of common scenarios. This leads to discussions on prioritising concerns, weaning/stopping medications, counselling patients on the effects of Opioids and Gabapentinoids and involving community teams aiming for successful reductions of addiction forming medications. Other gems include a discussion of the potential long term risks of Proton Pump Inhibitors and advice on weaning, remembering to consider anticholinergic burdens as well as handy resources for tackling Polypharmacy, Structured Medications Reviews and medication reductions.
You can use these podcasts as part of your CPD - we don’t do certificates but they still count :)
Useful resources: 
Greater Manchester Medicines Management Group: Inappropriate Polypharmacy Review and Treatment Optimisation: Resource Pack (from Dec 2022, accessed Dec 2023): https://gmmmg.nhs.uk/wp-content/uploads/2023/02/GMMMG-Polypharmacy-resource-pack-v3.0.pdf
Scotland Polypharmacy Resources for Professionals and for Patients: https://www.polypharmacy.scot.nhs.uk/for-patients-and-carers/
Scottish Polypharmacy Guidance 2018: https://www.therapeutics.scot.nhs.uk/wp-content/uploads/2018/04/Polypharmacy-Guidance-2018.pdf
Lewis T. Using the NO TEARS tool for medication review. BMJ. 2004 Aug 21;329(7463):434. doi: 10.1136/bmj.329.7463.434. PMID: 15321901; PMCID: PMC514207 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC514207/
Toolkit for General Practice in Supporting Older People Living with Frailty (includes a great Appendix of the STOPP/START criteria (2017): https://www.england.nhs.uk/wp-content/uploads/2017/03/toolkit-general-practice-frailty-1.pdf
An example of an Anticholinergic Burdon Resource from West Essex CCG 2020: https://westessexccg.nhs.uk/your-health/medicines-optimisation-and-pharmacy/clinical-guidelines-and-prescribing-formularies/04-central-nervous-system/61-anticholinergic-side-effects-and-prescribing-guidance/file
Canadian Resource for Deprescribing including reducing medications and some patient information leaflets: https://deprescribing.org/
Resource for help reducing and stopping medications: https://medstopper.com/
Me and My Medicines Resource for Patients to look through their medications before reviews or for information: https://meandmymedicines.org.uk/
Anticholinergic Medications and Risks of Dementia Cochrane Editorial with Reports in Link (Sept 2021): https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.ED000154/full
Anticholinergic drugs and risk of dementia: Time for action? British Pharmacological Society. Bell B et al Jun 2021 (9:3). Accessed 15/1/2024:  https://bpspubs.onlinelibrary.wiley.com/doi/full/10.1002/prp2.793
Cognitive Effects of Anticholinergic Load in Women with Overactive Bladder. Clin Interv Aging. 2020; 15: 1493–1503: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7457731/
Greater Manchester Medicines Management Group: Management of Overactive Bladder Including a simple Bladder Diary before and after stopping Medications (Jun 2019): https://gmmmg.nhs.uk/wp-content/uploads/2021/08/Management-of-OAB-in-adults-v3-0-approved-Aug-2019.pdf
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We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our quick anonymous survey here: https://pckb.org/feedback
Email us at: [email protected]
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This podcast has been made with the support of GP Excellence and Greater Manchester Integrated Care Board. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions. 
The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen.
Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk.
The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Doctors Sara and Lisa talk to Dr Sadaat Ahmed about Frailty. We discuss definitions, frailty syndromes, frailty scores and the need to take care with these. We talk through a case to showcase how recognising frailty and managing the controllable areas can make a big difference to patients' lives and slow or even sometimes reverse frailty. 
You can use these podcasts as part of your CPD - we don’t do certificates but they still count :)
Useful resources: 
British Geriatrics Society Fit For Frailty Guidelines: https://www.bgs.org.uk/resources/resource-series/fit-for-frailty
British Geriatrics Society Comprehensive Geriatrics Assessment Primary Care Toolkit: https://www.bgs.org.uk/resources/resource-series/comprehensive-geriatric-assessment-toolkit-for-primary-care-practitioners
National Osteoporosis Guidelines Group: https://www.nogg.org.uk/
British Geriatrics Society Frailty eLearning Hub: https://www.bgs.org.uk/elearning-0
The dangers of diagnosing frailty based on automatically calculated electronic Frailty Scores: https://www.england.nhs.uk/wp-content/uploads/2017/04/gms-contract-batch-coding-statement.pdf
RCGP Internal and External Resources around Frailty: https://www.rcgp.org.uk/your-career/gp-extended-roles/Useful-resources-for-frailty
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We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our quick anonymous survey here: https://pckb.org/feedback
Email us at: [email protected]
___
This podcast has been made with the support of GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions. 
The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen.
Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk.
The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Doctors Sara and Lisa talk to Dr Aseem Mishra, Academic GP trainee involved in helping produce the Guidelines for the Greater Manchester Lipid Pathway. Greater Manchester has very high levels of Major Adverse Cardiovascular Events (MACEs). The guidelines for how to treat hyperlipidaemia and what we’re aiming for have changed. Dr Mishra helps talk through these changes.  Towards the end of the episode, we discuss injectable treatments for secondary prevention including Inclisiran. The resource links are extensive, we hope you find the discussion and the links as useful as we do. 
You can use these podcasts as part of your CPD - we don’t do certificates but they still count :)
Useful resources: 
NICE Clinical Knowledge Summaries for Lipid Modification Jan 2023 (links to both Primary and Secondary Prevention): https://cks.nice.org.uk/topics/lipid-modification-cvd-prevention/
Familial Hypercholesterolaemia Assessment Guidelines (links to Simon Broome and the Dutch Lipid Clinic Criteria): https://cks.nice.org.uk/topics/hypercholesterolaemia-familial/diagnosis/assessment-diagnosis/
Statins Prescribing Information, with risks of serious side effects and interactions: https://cks.nice.org.uk/topics/lipid-modification-cvd-prevention/prescribing-information/statins/#adverse-effects
National Statin Intolerance Pathway: https://www.england.nhs.uk/aac/publication/statin-intolerance-pathway/
Manchester Secondary Prevention Lipid Pathway: https://gmmmg.nhs.uk/wp-content/uploads/2023/02/Lipid-Management-Pathway-for-Secondary-Prevention-of-Cardiovascular-Disease-CVD-21.12.22.pdf
GMMMG Prescribing Information for Inclisiran: https://gmmmg.nhs.uk/wp-content/uploads/2022/11/Inclisiran-prescribers-information-leaflet-13.10.22-for-web.pdf
SPIRIT Trial on Inclisiran: https://clinicaltrials.gov/ct2/show/NCT04807400
NHS Accelerated Access Collaborative: https://www.england.nhs.uk/aac/what-we-do/innovation-for-healthcare-inequalities-programme/commercial-partnerships/
Health Innovation Manchester Lipid Webinar and Links to Prescribers and Patient Information for Inclisiran: https://healthinnovationmanchester.com/cvdprevention-lipidpathway-resources/
HeartUK resource on Statins: https://www.heartuk.org.uk/getting-treatment/statins
Reference for the discussion on Plaque Regression: Kalanuria A, Nyquist P and Ling G. (2012) The prevention and regression of atherosclerotic plaques: Emerging Treatments Vascular Health Risk Management: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3459726/
Tool to Calculate Lifetime Cardiovascular Disease risk: https://u-prevent.com/
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We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://pckb.org/feedback
___
This podcast has been made with the support of GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions. 
The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen.
Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk.
The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Doctors Sara and Lisa talk to GP Dr David Bartlett who works with the Neuroendocrine Cancer UK charity and GP Dr Will Evans who is a researcher specialising in rare diseases. We wanted to discuss how they  approach finding rare diseases in General Practice whilst balancing this with the risk of over investigating. We start with definitions and classifications before discussing where neuroendocrine cancers fit into this landscape. Their pearls of wisdom could help us keep our antenae up, referrals helpful and resources for clinicians and patients well stocked. 
You can use these podcasts as part of your CPD - we don’t do certificates but they still count :)
Useful resources: 
British Journal of General Practice Article: Rare diseases in General Practice: Recognising the Zebras among the Horses. Evans, W & Rafi I (Vol 66, 2016): https://bjgp.org/content/66/652/550
Rare Disease UK: https://www.raredisease.org.uk/
Neuroendocrine Cancer UK: https://www.neuroendocrinecancer.org.uk/
Royal College of GPs eLearning on Neuroendocrine Cancers (search here): https://www.rcgp.org.uk/learning-resources/courses-and-events/elearning-courses
Medics for Rare Diseases: https://www.m4rd.org/
Information on Beckwith Wiedemann Syndrome: https://www.gosh.nhs.uk/conditions-and-treatments/conditions-we-treat/beckwith-wiedemann-syndrome-bws/
Inattentional Bias Studies with Radiology:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3964612/
https://pubmed.ncbi.nlm.nih.gov/17412097/
Mnemonic Family GENES Reference: Genetic red flags: clues to thinking genetically in primary care practice. Whelan et al. Primary Care: Clinics in Office Practice (Sept 2006): https://pubmed.ncbi.nlm.nih.gov/15331244/
Resource with helpful leaflets for Chromosomal Diseases: https://rarechromo.org/
OMIM: An Online Catalogue of Human Genes and Genetic Disorders: https://www.omim.org/
Gene Reviews: https://www.ncbi.nlm.nih.gov/books/NBK1116/
Orphanet Rare Disease Platform with Search Engine: https://www.orpha.net
Rare Disease Search Engine: https://www.findzebra.com/https://www.ndr-uk.org/browse
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We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://pckb.org/feedback
___
This podcast has been made with the support of GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions. 
The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen.
Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk.
The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Drs Lisa and Sara are joined by GP Dr Nikesh Vallabh, Consultant Cardiologist Dr Karthikeyan and Consultant Gastroenterologist Dr Bliss to discuss advice and guidance.
For those unfamiliar, the advice and guidance system came about to try to ease pressure on the long outpatient waiting lists, providing a different way of managing some cases. It is in place for a number of specialties for primary care clinicians to ask questions to consultants, getting an answer that will help guide patient care within a matter of short weeks at most. We talk about the system and where it can fit in to make a difference to patient care. We take the opportunity to go through some common themes and glean learning points from these to help our own practice.
Useful resources: 
Wigan, Wrightington and Leigh have their own LFTs guideline that should be available on the intranet or contact the local CCG
BMJ LFTs Algorithm 2017: https://www.bsg.org.uk/wp-content/uploads/2019/12/Guidelines-on-the-management-of-abnormal-liver-blood-tests.pdf
Greater Manchester Guidelines for managing patients with dyspepsia in primary care: https://gpexcellencegm.org.uk/resources/guidelines-for-managing-patients-with-dyspepsia-in-primary-care/#.YFEP4C2l23U
NICE guidelines Chronic Heart Failure in Adults: Diagnosis and Management (2018) https://www.nice.org.uk/guidance/ng106
___
We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://pckb.org/feedback
____
This podcast has been made with the support of Greater Manchester Health and Social Care Partnership, GP Excellence, Greater Manchester Training Hub and the GP Fellowship Programme, as well as Wigan Borough CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions. 
The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen.
Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk.
The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Lisa and Sara talk to GP and Professor of General Practice Research Carolyn Chew Graham about Long COVID. We discuss what Long COVID is, its prevalence, and how to assess and manage those presenting with symptoms of possible Long COVID in primary care. We also talk about the condition in children, Long COVID clinics, and how to support patients on this still very new journey. Hopefully this episode will help support learning for the new Long-COVID enhanced service that has recently been launched by NHS England.
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NICE COVID-19 rapid guideline: managing the long-term effects of COVID-19 [NG188] Published: 18 December 2020: https://www.nice.org.uk/guidance/ng188
The Post-hospitalisation COVID-19 study (PHOSP-COVID): https://www.phosp.org/
British Thoracic Society Resources for the respiratory Community about COVID-19 (includes advice on chest x-rays and COVID): https://www.brit-thoracic.org.uk/covid-19/covid-19-information-for-the-respiratory-community/
Your COVID recovery resource: https://www.yourcovidrecovery.nhs.uk/app/
Long COVID SOS support group for patients: https://www.blf.org.uk/support-for-you/long-covid
UK Doctors with Long COVID Facebook Group: https://www.facebook.com/groups/479687042869493/
BJGP Open Article: Finding the 'right' GP: a qualitative study of the experiences of people with long-COVID 2020: 4(5) Kingstone T, Taylor AK, O'Donnell CA, Atherton H, Blane DN and Chew-Graham CA: https://bjgpopen.org/content/4/5/bjgpopen20X101143
Health Expectations Article: 'Reluctant pioneer': A qualitative study of doctors' experiences as patients with long COVID (Mar 2021) Taylor AK, Kingstone T, Briggs TA, O'Donnell CA, Atherton H, Blane DN, Chew-Graham CA: https://onlinelibrary.wiley.com/doi/10.1111/hex.13223
The Royal College of General Practitioners online learning module on Long COVID:https://elearning.rcgp.org.uk/course/view.php?id=492
Article, The Conversation: Aiyegbus OL, Haroon S, (July 2021) Long COVID: symptoms experienced during infection may predict lasting illness: https://theconversation.com/long-covid-symptoms-experienced-during-infection-may-predict-lasting-illness-164649?utm_source=twitter&utm_medium=bylinetwitterbutton
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We welcome any feedback you might have, our survey takes 1-2 minutes: pckb.org/feedback or contact us on Twitter @PCKBpodcast
___
This podcast has been made with the support of Greater Manchester Health and Social Care Partnership, GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions. 
The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen.
Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk.
The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Lisa and Sara talk to Consultant Cardiologist Dr Karthikeyan about palpitations and atrial fibrillation.
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Resources mentioned in the episode:
BMJ best practice article about pheochromocytoma: click here (requires login)
NICE CKS, anti-coagulation: click here
NICE CKS atrial fibrillation: click here
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Have feedback or suggestions? You can help us know how we are doing with our 5 minute survey: click here
 ____
This podcast has been made with the support of Wigan CCG. Given that they are recorded with Wigan clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions. 
The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen.
Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk.
The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Lisa and Sara talk to Consultant Cardiologist Dr Karthikeyan about cardiac causes for blackouts.
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Resources mentioned in the episode:
- GMC guidance on reporting driving concerns: click here - DVLA fitness to drive guidance: click here 
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Have feedback or suggestions? You can help us know how we are doing with our 5 minute survey: click here 
 ____
 
This podcast has been made with the support of Wigan CCG. Given that they are recorded with Wigan clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions. 
The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen.
Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk.
The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Lisa and Sara talk to Consultant Cardiologist Dr Arya about Heart failure.
Have feedback or suggestions? You can help us know how we are doing with our 5 minute survey: https://www.surveymonkey.co.uk/r/YYQ763C
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This podcast has been made with the support of Wigan CCG. Given that they are recorded with Wigan clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions. The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.