Preview of the Autumn 2014 Hot Topics GP Update Course

We are all very excited about our upcoming Autumn series of the Hot Topics GP Update course starting next month. We have been working very hard trawling through all the guidelines, research and papers for you finding the evidence which is recent, reliable and above all relevant to primary care.

Compared to previous editions of the course we will be covering slightly fewer topics, but in more detail.  When discussing controversial new guidelines (they’ve been a few recently!) we shall focus  on the primary research that underpins them, to help you and your patient make informed decisions about changes to practice.

All the presented Hot Topics will be new compared to Autumn  2014  so if you last came a year ago, do come back.

Topics which we will be presenting will include:

•  Polypharmacy, taking a safe, effective and evidence-based approach
• Cardiovascular disease

o   The new guidelines for Atrial Fibrillation, Statins & Lipids and Hypertension and the primary evidence that underpins them

•  Kidney: Chronic Kidney Disease and Acute Kidney Injury
• Diabetes

o   Personalizing HbA1c targets

o   What next after metformin?

•  End of Life Care and Palliative Care
•   Cancer, early diagnosis 
• Mental illness

o   Psychosis and Schizophrenia

o    The serotonin syndrome

o   Obsessive compulsive disorder

• Medically unexplained symptoms
• Chronic pain
• Simple musculoskeletal problems e.g. carpal tunnel syndrome, gout
• Paediatrics

o   Asthma and allergic rhinitis

• Gastroenterology

o   GORD and dyspepsia

• Abnormal blood tests

o   A new section on management of abnormal blood tests, including of Vit B12 deficiency

In addition:

• We have streamlined the paper book, and included more of our ever popular KISS (keep it simple) summaries.
• The electronic version of the book has been developed to become an invaluable resource to use during your working day. It is a PDF you can download onto all of your devices (computer, phone, tablet etc). It is instantly searchable. Original sources are hyperlinked, and the KISS summaries contain direct links to resources for you and your patients to make life easier for you.
• You will be emailed pre and post course MCQs so that you can test your knowledge and demonstrate your learning
• We have summarized the evidence in important areas related to service provision e.g. reducing unplanned admissions, efficacy of health checks and telephone triage

We focus on the things which are most likely to have an impact on your practice. A survey from our Spring 13 courses showed that 97% of our delegates changed practice as a result of the course, and over 70% use the course material at least weekly to find an evidence-based answer to a clinical problem.

As ever we also want you to have a relaxing and fun day out of the practice, so we will keep the atmosphere light, with some good new funny clips and we really hope you have an enjoyable day. With GPs being so busy, we are convinced that this model provides us the best way of practising patient-centred evidence based medicine. So, do come along and we look forward to seeing you next month!

Simon, Neal, Gail and Kevin

Levels of Evidence

To help you to make more informed decisions, from Autumn 2014 on the Hot topics course we will grade the level of the evidence (from research studies) and the strength of recommendations (from guidelines) wherever possible. 

Grading of evidence

This is an internationally recognized ranking system used in evidence based medicine to rank the quality of the evidence and therefore the strength of the conclusion you can take from it.

Evidence level	Evidence is from:
1a	A systematic review & meta-analysis of randomized controlled trials
Ib	At least one randomized controlled trial
11a	At least one well-designed study, but not randomized e.g. prospective cohort study
11b	At least one well designed experimental, but not controlled, trial
111	Well designed descriptive studies e.g. case-control, comparative studies and case series
1V	A panel of experts

Grading of recommendations

Guidelines then use a grading hierarchy to grade the strength of the recommendations they make. Confusingly, there are several different models in use but the most accepted one (which we have tried to follow) is the GREG (Guideline Recommendation and Evidence Grading) system:

Grade of recommendation	Based on:
A (Recommendation)	There is robust evidence to recommend a pattern of care (based on level 1 evidence)
B (Provisional recommendation)	On balance of evidence, a pattern of care is recommended with caution (usually based on hierarchy 11 evidence)
C (Consensus opinion)	On absence of directly applicable studies of sufficient quality, a pattern of care is recommended by consensus

For simple guidance on Evidence Based Medicine (e.g. how to tell your ARR from your RRR, different study types, how to calculate a NNT and what it means, how to interpret confidence intervals etc) please download our free KISS Guide to Evidence Based Medicine.

 For more on evidence levels, there is an excellent PatientPlus summary and see also the Centre for Evidence Based Medicine

Patient-Based Medicine

PBM: Patient-Based Medicine

"The art of medicine is a literary art. One that requires of the practitioner the ability to listen in a particular way, to empathise, but also to imagine. To try to feel what it must be like to be that other person lying in the sick bed, or sitting across the desk from you. To try to understand the storyteller, as well as the story." Cecil Helman, GP

'Clean clear water transformed health in 19thC; clean clear knowledge will transform health in the 21st Century', Sir Muir Gray

Inspired by both Helman and Gray we aim to practise, and teach, what we apologetically call Patient-Based Medicine. 

For those unfamiliar with it, Suburban Shaman is a wonderful book by the late great GP Cecil Helman (obituary, BMJ2009:339;b2904). He made his name with Culture, Health and Illness but Suburban Shaman is an autobiographical celebration and affirmation of General Practice, an entertaining and funny read. Helman firmly believes in a non-medicalised whole-person model of care, in which the patient’s unique cultural background and circumstances are inseparable from their experience of illness. He sees many similarities with the role we play in the community with that of healers, or shamans, in traditional cultures. He writes ‘beyond the disease is the person, but beyond the person are always the time and place and particular circumstances in which they live and die’.  

We mention this here because NB Medical’s Hot Topics course is all about helping GPs with keep up with ‘the knowledge’: clinical evidence, guidelines and all the other new developments that come our way. We agree with Muir Gray, and believe we really do need to be aware of this information so that we can offer our patients the best treatments available, but all has to be interpreted in the light of the unique circumstances in which we and our patient find yourself.  EBM is often criticized for being reductive, de-personalizing ‘cook book’ medicine but  this is not so as its definition makes clear: ‘EBM is the integration of the best available evidence with our clinical expertise and our patients’ unique values and circumstances’ (EBM2007:12:1).  As patients we want our doctors to consider us as unique people, rather than conditions, and to try to understand us in our context. But at the same time we really do want them to know that if we turn up with Bell’s Palsy that 50mg of prednisolone for 10 days is an effective treatment. And, if we don’t know, where and how we can find the answer.

We at NB passionately believe in Patient Based Medicine. This is personalised, patient-centred care based on the best available scientific evidence. Our role is to try to understand our patients, to help them to make sense of their problems and to empower them to make informed choices. These choices should be evidence-based, but ultimately it’s ALWAYS the patient’s call.

Simon