Previews – CDE

Cardiovascular | Diabetes & Endocrinology | ENT

Lisa FreemanAtrial Fibrillation
Leisa Freeman (Consultant Cardiologist)

Leisa Freeman is a Consultant Cardiologist, Norfolk and Norwich University NHS Hospital Trust, Honorary  Senior Lecturer UEA School of Medicine Health Policy and Practice and Honorary Consultant Cardiologist (GUCH) Papworth Hospital

Leisa specialises in General adult cardiology, Cardiac catheterization (coronary angiography), and has a Sub specialist interest in Congenital heart disease in the adult including inherited heart muscle and rhythm problems.
This talk by Leisa Freeman will explain all you need to know about atrial fibrillation. This is an important lecture, as AF is a common pathology amongst our patients, and a major risk factor for stroke. The emphasis here is on understanding how it is managed medically, and the treatment options available across the range of problems that can present.

This is a comprehensive account and will cover all a GP will encounter, and give an understanding of the way in which patients can be managed in secondary care.

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Paul GuylerA GP Guide to Atrial Fibrillation
Paul Guyler (Lead Consultant for Stroke)

Dr Paul Guyler is the Lead Consultant Stroke Physician at Southend University Hospital. He also works as an Associate for the Stroke Improvement Programme, particularly in the areas of hyperacute stroke and atrial fibrillation, and has been Lead for Acute Stroke in Essex Cardiac and Stroke Network; now leading on research and innovation.
His lecture recorded here is a comprehensive update on atrial fibrillation that will refresh your knowledge and review the evidence base for management

Atrial fibrillation is common and highly variable in its clinical presentation and evolution; it causes substantial morbidity and mortality, including impaired quality of life, heart failure, systemic emboli, and stroke.
Atrial fibrillation is the commonest sustained arrhythmia encountered in clinical practice. Its prevalence increases with age, rising from 0.7% in people aged 55-59 years to 18% in those older than 85 years. Consequently, the public health burden associated with atrial fibrillation is increasing. The therapeutics of atrial fibrillation is evolving. In recent years, publication of several randomised controlled trials and meta-analyses have improved our understanding.
The first priority is to control heart rate (if tachycardia is present) and provide adequate antithrombotic treatment for preventing complications of embolism.
Patients with moderate to high risk of stroke require warfarin long term for preventing embol.

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Liam HughesCoronary Heart Disease
Liam Hughes (Interventional Cardiologist)

As a Norfolk based interventional cardiologist, Dr Hughes has spent the 11 years since appointment to the Norfolk and Norwich University Hospitals NHS Foundation Trust developing cardiac interventional treatments. He now has considerable experience in all the major interventional techniques, especially stenting for multivessel coronary disease and acute coronary syndrome.

His talk is an important review of angina and a reminder of how much stenting has transformed the management of acute coronary syndrome. There are some insightful points made about the definition of angina and he describes common pitfalls in diagnosis in stable angina and useful markers of ischaemic disease. The accuracy of exercise tolerance testing and other functional methods of diagnosis is discussed and there is a graphic demonstration of the importance of angiography and stent insertion in management.

You will enjoy this lecture.

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Kneale MetcalfHow do I diagnose a TIA?
Kneale Metcalf (Consultant Physician)

Dr Kneale Metcalf is a Consultant Physician and Stroke Physician in Norwich. He spends the majority of his time working with patients who have had a stroke. His experience working with patients shows throughout this lecture as he discusses how important TIAs are. Kneale thinks of them as emergencies, and his enthusiasm for their appropriate and timely management shows through.

After discussing what TIAs are he talks about how they present. His insights into how they present are illuminating. TIA mimics, scenarios where the diagnosis can be made erroneously are dealt with at length. He then discusses investigations, including the Diffusion Weighted Imaging MRI, the predicted effect of treatment, and the management of risk factors.

The message of his talk is that A TIA is an index event signifying high risk. Urgent response is essential.

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Anne WhiteInherited Cardiac Conditions & Sudden Death
Anne White (BHF Cardiac Genetics Specialist Nurse)

Anne White is a cardiac genetics specialist nurse working at Papworth hospital. Her talk here is a review of the inherited cardiac diseases, the cardiomyopathies and diseases of abnormal conduction, and sudden adult death syndrome.

There are several very important disease entities here that will interest GPs. Anne concludes with the subject of screening and the needs of families that are affected by these inherited diseases.

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Anne WhiteCardiac and genetic testing
Anne White (BHF Cardiac Genetics Specialist Nurse)

Anne White is a cardiac genetics specialist nurse working at Papworth hospital.

This is actually Part 4 of her talk on inherited cardiac conditions and sudden death. Here Anne discusses family screening and genetic testing.

As GPs we are all aware that this subject comes up at irregular intervals in our clinical lives, usually when we are asked about patient risk arising from a clinical finding or event in one of their relatives. This lecture will prime your knowledge and prepare you for the next occasion you are asked.

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Ian WilliamsPacemakers
Ian Williams (Consultant Cardiologist)

Ian Williams is a Consultant Cardiologist who specialises in electrophysiology and the assessment of arrhythmais and syncope. He has a special interest in the Device management of heart failure
After discussing the technology of pacemakers and their indications, Ian talks about biventricular pacemakers and their indication of severe heart failure. Ian talks about the indications for referal, which will be of interest to us all.
Biventricular pacing therapy is recommended for patients in sinus rhythm with a widened QRS interval (>=120 ms) and severe LV systolic dysfunction LVEF (<=35%) who have persistent, moderate to severe HF (NYHA III) despite optimal medical therapy.
Finally this lecture deals with implantable defibrillators, their technology and indications.
The important lesson from this lecture is that the UK, when compared with the rest of Europe, lags well behind in the International league tables.
A lecture that should stimulate interest amongst GPs for a review of our referal policies for patients with heart failure, as well as a general update on implantable cardiac support devices.

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Diabetes & Endocrinology

Saeed AhmedChronic Kidney Disease
Saeed Ahmed (Consultant Nephrologist)

Chronic kidney disease (CKD) is common, frequently unrecognised and often exists together with other conditions (for example, cardiovascular disease and diabetes). Saeed Ahmed is a consultant nephrologist practising in Sunderland, and his lecture here is an essential overview of the subject for GPs.
CKD has a high risk of mortality and early recognition and treatment can prevent or delay its impact on health, reducing or preventing
the development of complications and reducing the risk of cardiovascular disease.

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Ketan DhatariyaDiabetes
Katen Dhatariya (Consultant in Diabetes and Endocrinology)

Ketan Dhatariya is a Consultant in Diabetes, Endocrinology and General Medicine and Hon Senior Lecturer in Medicine, University of East Anglia. He is a member of the ABCD National committee as well as having several other national roles  commissioning guidelines. During the early part of his career he worked as a GP.  He spent  2 years as a research fellow in endocrinology at the Mayo Clinic in Minnesota returning as a locum consultant at King's College Hospital and the Homerton Hospital (both in London), until his appointment at the Norfolk & Norwich University Hospital which he commenced in September 2004.

Ketan gives an overview of how important diabetes is to overall cardiovascular health and risk reduction. He then discusses each of the important diabetic agents and their place in treatment. The oral agents are introduced and reviewed by group , and the major insulin types are discussed.

This lecture will enable you to keep up to date with the core diabetes management lessons that every GP should know about.

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Garry JohnLaboratory Diagnosis Diabetes
Garry John (Consultant Clinical Biochemist)

Professor Garry John is a Consultant and Honorary Professor of Clinical Biochemistry and was Chairman of the IFCC Working Group for HbA1c Standardisation.
The accepted glucose cut-off values for diagnosis have changed a number of times. In 1979 the WHO criteria included the measurement of glucose tolerance using 7.8 mmol/L as a fasting cut-off and 11.1 mmol/L as the cut-off two hours post glucose load. The fasting value was revised down to 7.0 mmol/L in 1997 along with inclusion ofsymptoms in the criteria and the introduction of impaired fasting glucose.
The use of HbA1c for the diagnosis of diabetes is the next development, albeit seemingly changing the definition of diabetes from hyperglycaemia to hyperglycation.

An HbA1c of 48 mmol/mol (6.5%) or greater is considered to be diagnostic of diabetes.
What has precipitated this development? And what does it all mean?
Professor John explains the biochemistry and and the application of the Hba1c test to clinical diagnosis. A perfect diagnostic algorithm , he states, has not yet been perfected, but may be possible. This is understandable once you have digested this lecture; Hba1c can mis-diagnose some individuals, and on a population basis, some diagnoses may be delayed. It is a simple to perform test, but not so simple to understand what it actually means. A definite must-attend lecture for any GP.

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Abbi LulseggedVitamin D deficiency
Abbi Lulsegged (Consultant Physician)

Abbi Lulsegged is a Consultant Endocrinologist & General Physician at the South London Healthcare NHS Trust (Princess Royal University Hospital), where he is a general endocrinologist with an interest in Thyroid, Parathyroid disease, calcium disorders PCOS and Female reproductive endocrinology. He also has an interest in nutrition as applied to diseases.

There is growing awareness about the importance of vitamin D, both by patients and amongst the medical profession. There are now guidelines for routine maintenance supplements for at -risk groups. This lecture by Abbi Lulsegged is very timely, outlining as it does the main evidence for supplementing vitamin D in a variety of situations. Whether it is reducing the incidence of Type 1 diabetes amongst Norwegian children ( 88% risk reduction) or reducing the incidence of flu infections amongst asthmatic children (83% reduction) this talk will provide you with some fascinating talking points.
The lecture here starts by outlining the basic biochemistry and physiology of vitamin D, defines deficiency and what normal levels are.

Abbi then proceeds to look at how vitamin D deficiency impacts on a wide variety of disease entities, and the evidence base that exists.

His talk does ask some important questions about what vitamin D deficiency is and what doses we ought to use to manage it.

A very enjoyable lecture, highly recommended

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Abbi LulseggedHypothyroidism and pregnancy
Abbi Lulsegged (Consultant Physician)

Abbi Lulsegged is a Consultant Endocrinologist & General Physician at the South London Healthcare NHS Trust (Princess Royal University Hospital), where he is a general endocrinologist with an interest in Thyroid, Parathyroid disease, calcium disorders,PCOS and Female reproductive endocrinology. He also has an interest in nutrition as applied to diseases.

This is an important lecture about the management of hypothyroidism in pregnancy. Once watched you will be keen to overview your management protocols...

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ENT

John FitzGeraldBPPV- Benign  Paroxysmal Positional Vertigo
John FitzGerald (Consultant Clinical Scientist)

John Fitzgerald is a consultant clinical scientist. His account of BPPV is an excellent lecture that will enable you to be fully conversant with the subject of BPPV.

The aims of this lecture are to enable you to be confident in diagnosis and to be able to perform the Hallpike and Epley manoeuvres. This lecture demonstrates one of the main strengths of watching lectures online- the ability to rewind and rewatch a portion of the lecture on-demand. The demonstration of the two manoeuvres and the understanding of how to recognise nystagmus is made much easier when you can replay the lecture again as your needs dictate.

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Chris WadeSpeech and Language Therapy and Autism Spectrum Disorders
Chris Wade (Consultant Speech and Language Therapist)

Chris gained his first degree in BA (Hons) Linguistics at Lancaster University and his second degree in BSc (Hons) Clinical Language Sciences (Speech and Language Therapy) at Leeds Metropolitan University.
Chris is a Highly Specialist Speech & Language Therapist currently working for the NHS in London and a national charity in Cardiff. Whilst Chris has a breadth of experience he specialises in:

The diagnosis of children & adolescents aged 5-19 with Autism/Asperger's Syndrome (as part of a wider multi-disciplinary team).
The intervention (i.e. therapy and training others) of children aged 5-19 with Autism and Asperger's Syndrome; Down's Syndrome; Cerebral Palsy and speech/language delay/disorders.
Chris is trained in Picture Exchange Communication System (PECS), Intensive Interaction, Autism Diagnostic Observation Schedule (ADOS), Autism Diagnostic Interview-Revised (ADI-R), TEACCH, Paedatric and Adult Learning Disability Dysphagia, Sensory Behavioural Feeding, Interactive Storytelling (Lis 'n' Tell) and Alex Kelly Social Skills.

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