In this episode, which has been recorded for Chronic Conditions Month 2024, Dr Yassir Javaid (GP with a Specialist Interest in Cardiology) examines the role of the QRISK3 calculator in the primary prevention of cardiovascular disease. He considers the development of the tool, the differences between QRISK2 and QRISK3 (including the additional risk factors now included in the updated calculator) and the strengths and limitations of QRISK3 in understanding a person’s cardiovascular risk.More...

Diverticular disease is a condition characterised by the presence of small pouches, called diverticula, in the wall of the colon (large intestine). These pouches can develop when weak spots in the colon's muscular wall give way under pressure. Diverticular disease encompasses two main conditions: diverticulosis and diverticulitis. In this episode, Dr Roger Henderson takes an overview look at the symptoms and management of these as well as their prognosis and prevention.Access episode show...

Coeliac disease (CD) is a chronic autoimmune disorder that primarily affects the small intestine and is triggered by the consumption of gluten, a protein found in wheat, barley, rye and sometimes oats. When individuals with CD ingest gluten, their immune system responds by damaging the lining of the small intestine. This damage impairs the absorption of nutrients from food, leading to various symptoms and potentially serious complications. In this episode, Dr Roger Henderson looks at the...

In this episode, Dr Hannah Rosa takes a look around the world at some of the different strategies that are being used to try to reduce the health complications caused by alcohol. She then looks at the latest research which links alcohol as a primary cause of a variety of cancers, before finishing with a consideration of the economic cost.Access episode show notes containing key references and take-home points at:...

Obesity is a medical condition characterised by excessive accumulation of body fat, to the point where it may have adverse effects on health. Its incidence is steadily rising in both young people and adults. It is typically measured using BMI, but this has limitations and may not always accurately represent the level of obesity. While genetics and hormonal factors have a role in obesity, lifestyle choices (such as diet and physical activity level) and environmental factors also significantly...

Recurrent vulvovaginal candidiasis is reported in 6% of women of reproductive age. It has a significant impact on an individual’s quality of life that is comparable to conditions such as asthma and migraine. Appropriate management of the acute infection and subsequent maintenance treatment can help to reduce the burden of this condition. In this episode, Dr Kate Chesterman discusses the risk factors for recurrence and considers appropriate investigations. She looks at options for management,...

The most common cause of peptic ulcers (gastric and duodenal) is infection with Helicobacter pylori (H. pylori) or the long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs). Other factors such as excessive alcohol consumption, smoking, stress and certain medical conditions may also contribute to the development of peptic ulcers. Symptoms of peptic ulcer disease can vary but may include burning stomach pain, nausea and vomiting, bloating or belching and loss of appetite. Treatment...

Dysphagia refers to difficulty swallowing. It can occur at any age and may be caused by various conditions, including neurological disorders, muscular disorders, structural abnormalities, or even psychological factors. Dysphagia can range from mild to severe, and it can lead to complications such as malnutrition, dehydration and aspiration pneumonia if not properly managed. The treatment for dysphagia depends on the underlying cause and may include dietary modifications, swallowing therapy,...

Trigeminal neuralgia (TN) is a condition characterised by severe, shooting pain in the face, along the trigeminal nerve. The pain can be triggered by even mild stimulation of the face, such as brushing teeth, touching the face or eating. It is often described as one of the most excruciating pains known to medicine and it can significantly impact a person's quality of life. The exact cause of trigeminal neuralgia is often unknown and treatment options include carbamazepine or gabapentin, as...

Anal fissures are small tears or cracks in the lining of the anus which can cause pain, bleeding and discomfort, particularly during bowel movements. They are quite common and can be caused by various factors such as constipation, diarrhoea, childbirth or anal trauma. Treatment often involves keeping the stool soft and avoiding straining during bowel movements. This may include dietary changes, fibre supplements, topical medications, or in some cases, surgery. In this episode – which has been...

Haemorrhoids are a very common finding in the Western world and are often seen in our surgeries. They are frequently under-reported so their exact incidence can be difficult to quantify; however, estimates are that 50% of the population experience them by the age of 50. Because many people attribute symptoms of more serious pathology to haemorrhoids, careful evaluation is always very important. Fortunately, most cases are simple to treat and often resolve very quickly, although up to 10% of...

We live in an age of increasing digital connectivity where technology plays an ever-prominent role in peoples’ lives. While social media can provide a platform for support and connection, we are all susceptible to the negative effects of overuse or misuse, particularly on our sleeping patterns and our mental health. In this episode, the second in a series on digital wellbeing, Dr James Waldron interviews Dr Alex Lai of the WorkWell Doctors about the patient perspective. It explores how we...

Lateral hip pain is a common presenting complaint in primary care. It can result in significant morbidity with reduction in activity levels and associated implications for leisure activities, employment and overall wellbeing. In this episode, Dr Kate Chesterman reviews the likely differential diagnoses, including some key questions to consider when assessing a patient with lateral hip pain. She then delves deeper into the diagnosis of greater trochanteric pain syndrome (GTPS), exploring the...

We are constantly connected to the web! You are likely connected right now, trying to decide what podcast to listen to! In this episode, Dr James Waldron interviews Dr Alex Lai of the WorkWell Doctors in the first of a series about staying well in an increasingly digital world. How do we check in with our use of digital tools? What impact might it have on our concentration and mental health? All will be explored in this episode.Access episode show notes containing key references and take-home...

Bowen's disease, also known as squamous cell carcinoma in situ, is a type of skin disorder characterised by the presence of precancerous or intra-epidermal squamous cell carcinoma. It was named after John T. Bowen, the dermatologist who first described the condition in 1912. Bowen's disease primarily affects the outermost layer of the skin (epidermis) and is considered a form of non-invasive skin cancer. Bowen's disease most commonly occurs on sun-exposed areas of the skin, such as the face,...

Obsessive–compulsive disorder (OCD) is a prevalent mental health condition characterised by persistent, intrusive thoughts (obsessions) and repetitive behaviours or mental acts (compulsions) aimed at alleviating anxiety. Individuals with OCD often find themselves trapped in a distressing cycle, as compulsions provide only temporary relief, perpetuating the need for repetition. OCD manifests in diverse forms, such as checking, counting or washing rituals, and its severity can range from mild...

NICE published its last guideline on depression in 2009. Since that time, the prevalence of depression has increased, especially among vulnerable adults during the COVID-19 pandemic. NICE published a new guideline in June 2022 to reflect this. In this episode, Dr Roger Henderson looks at the new recommendations on managing depression in primary care, along with services providing psychological therapies that update and replace the 2009 guideline. Among the topics covered are treatments for...

Many pathology tests are ordered unnecessarily in primary care and this can include testing for inflammatory markers. The most common examples of tests typically ordered are for erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels, with occasional requests for plasma viscosity (PV) too. Although such tests can be useful in giving some information as to a patient’s inflammatory response in certain conditions, their lack of specificity means that they are not perfect tests...

Sweating is a crucial way to reduce our body temperature, such as when doing strenuous physical activity or when in a hot environment. Hyperhidrosis is defined as excessive sweating beyond what is physiologically required or normal. It can be categorised as primary (idiopathic), secondary to other conditions, or as a side effect of some medications. Primary hyperhidrosis can affect people at any age, but often starts in early life. The diagnosis of hyperhidrosis is typically made initially on...

Testosterone deficiency (TD) is an increasingly common problem with significant health implications, but the diagnosis and management of this condition may present problems in primary care. Low levels of testosterone in men are associated with increased risk of incident type 2 diabetes mellitus, worse outcomes in chronic kidney disease and COVID-19 infection (with increased all-cause mortality), along with significant implications in the areas of mental health and relationships. In this...

Dry skin is an extremely common condition that occurs in all skin colours and ethnic groups; however, differences in skin colour can cause significant differences in the incidence, presentation and treatment of different skin conditions. Although dry skin may cause similar symptoms among different skin tones, the appearance may make it more challenging to easily recognise – a fact highlighted by hospital admissions linked to eczema being up to six times more likely in people of colour than in...

Although pityriasis capitis (dandruff) is not a serious medical condition, it causes significant embarrassment and self-esteem issues in many people who suffer from it. It is extremely common, affecting up to half the global adult population, and its recurring nature is often a source of frustration. It can impact on primary care workload and can also be mistaken for other scalp conditions such as scalp psoriasis, seborrheic dermatitis or atopic eczema. In this podcast Dr Roger Henderson...

Lyme disease can present a number of particular difficulties in primary care, and these are often linked to clinical findings and the availability and timing of testing. In this podcast, Dr Roger Henderson discusses those and looks at Lyme disease’s three stages — early, disseminated and late — and whether it can be diagnosed clinically if erythema migrans is or is not present. He also looks at diagnostic difficulties and whether acute or convalescent serological testing is helpful. Treatment...

With tourism having now rebounded from the declines during and after the coronavirus pandemic, our patients are once again travelling globally. But what happens when their destination is 5000 metres above sea level? Many GPs will have been faced with a “travel consultation”, but it can be a daunting prospect when carried out infrequently. What are the risks of high altitude? What medication might be needed? And why might beer taste funny at high altitude? In this episode, Dr James Waldron...