Hot Topics Clinical Dr Sian Stanley

Why Hot topics? GPs love them. Recurring theme throughout GP training. Who decides what’s hot and what’s not? Clinically most likely questions are on Asthma, Diabetes and Hypertension. Recent developments Renal disease and Obesity.

Hypertension Very common in General Practice. Almost always diagnosed in primary care. Treatment usually instigated in Primary care One of our QOF targets. Aiming to get BP less than 140/90 but in diabetics 130/85.

Chronic Kidney Disease Cannot be measured directly so eGFR (estimated glomerular filtration rate) is used. It is estimated using the patients creatinine, age and gender, it needs to be adjusted for ethnicity. Until recently the emphasis has been on patients requiring dialysis or transplantation. Less severe kidney disease is actually quite common. This has recently been introduced as a QOF target.

5 stages of CKD >90mL/minCKD 1- normal mL/minCKD 2- normal.* 30-59mL/minCKD 3 mod imp 15-29mL/minCKD 4 Severe imp <15mL/minCKD 5 established renal failure *if has protienuria, haematuria,microalbuminuria, polycystic kidneys or reflux nephropathy. Do not regard as normal

Obesity ClassificationBMI (kg/m2) Healthy weight 18.5–24.9 Overweight 25–29.9 Obesity 1: 30–34.9 Obesity 2: 35–39.9 Morbid Obesity 3: 40 or more

Why should GPs be interested in a lifestyle choice? The department of health have recently pushed the issue of Obesity into General practice. There are now NICE guidance on the treatment of obesity. All V. controversial. See the cuttings. You would probably not be asked about the specifics of the management but you should have a well balanced opinion on it.

Asthma. Almost entirely managed within general practice. The stepwise progression of treatment very important. Now have much more emphasis on patient education and self management.

Conclusions ‘Hot’ topics are often focused on common or important clinical problems Have a sound understanding of core clinical skills and clinical knowledge Ensure you critically read medical journals but don’t ‘over-read’ Form a study group and discuss with ‘hot’ topics with colleagues