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Monkeypox

26 May 2022

Just when you thought you’d had quite enough of pandemics, monkeypox arrived! What do we in primary care need to know?

More info PDF

Monkeypox

Just when you thought you’d had quite enough of pandemics, monkeypox arrived! What do we in primary care need to know?

Click PDF for a short summary!

Breast cancer: genetic risk and how to reduce it!

19 May 2022

Uptake of the NICE guideline on familial breast cancer has been slow, and concern remains that women who could potentially benefit from preventative medication are not receiving it. Watch our video Byte on breast cancer genetics.

More info PDF

Breast cancer: genetic risk and how to reduce it!

Uptake of the NICE guideline on familial breast cancer has been slow, and concern remains that women who could potentially benefit from preventative medication are not receiving it. Watch our video Byte on breast cancer genetics.

“Ignorant GPs deny patients drugs that ward off cancer”, Daily Mail, 14 February 2017.

A wonderful example of 'post-truth' news! But uptake of the NICE guideline on familial breast cancer has been slow, and concern remains that women who could potentially benefit from preventative medication are not receiving it.

All women need a clinical genetics assessment before starting chemoprevention, and should be enabled to make a shared decision. After this, we can and should prescribe.

In this week’s Pearl, created in association with NHS Innovation, we consider:

  • How to sieve people with a higher-than-population risk of breast cancer.
  • How to take an effective family history.
  • Who to refer.
  • Risk reduction options, including preventative medication and when and how we can prescribe them safely in primary care.

Click PDF to read our Pearl article. You will also find a link in the article to a useful podcast.

Menopause GEMS

12 May 2022

This week we share our handy GEMS which is a go-to guide to HRT prescribing, and includes a list of all formulations so you can find alternatives to preparations that are not available. 

More info PDF

Menopause GEMS

This week we share our handy GEMS which is a go-to guide to HRT prescribing, and includes a list of all formulations so you can find alternatives to preparations that are not available. 

Menopause, HRT and Cognition

12 May 2022

The second ‘Davina menopause documentary’ broadcast last week focused largely on the mental health and cognitive effects of menopause, and will, no doubt, result in newly-informed women coming forward to seek treatment.

More info PDF

Menopause, HRT and Cognition

The second ‘Davina menopause documentary’ broadcast last week focused largely on the mental health and cognitive effects of menopause, and will, no doubt, result in newly-informed women coming forward to seek treatment.

Menopause is in the news again! This time, it’s because demand for HRT – mainly oestrogen gel – is outstripping supply. The rise in demand follows increased awareness of menopause due to Davina McCall’s Channel 4 documentary last year. Subsequent media campaigns calling for reduction in prescription charges for HRT and more recognition of the impact of menopause in the workplace have made menopause a high-profile issue. 
 
To help navigate the management of the mental health and cognitive effects of menopause with our patients, our Pearl covers the role of HRT in managing brain fog and cognitive decline. Click PDF to read the article.
 
At Red Whale, we endorse a holistic and evidence-informed approach to menopause care. We have loads of resources to help make counselling about menopause and decisions about HRT easier, including our enormously successful menopause half day webinar – watch our menopause teaser video to find out more!

Our Women's Health team recently recorded a podcast episode of Boggled Docs with Nik Kendrew, where they all discussed their thoughts on the latest 'Davina documentary'. Listen to the Boggled Docs podcast on menopause, HRT and cognition.

“Can I have some antibiotics to prevent prostate cancer?”

05 May 2022

Have you had an unusual request like this in the last few weeks? It might be down to recent headlines...

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“Can I have some antibiotics to prevent prostate cancer?”

Have you had an unusual request like this in the last few weeks? It might be down to recent headlines...

“Discovery of bacteria linked to prostate cancer hailed as potential breakthrough” – The Guardian

“Urine bugs may be a sign of aggressive prostate cancer” – BBC News

“5 types of bacteria linked to aggressive prostate cancer” – Bolton News

At Red Whale, the medical news on 20 April 2022 got us quite excited. Join us as we take a look behind the headlines, unearth the evidence and see how this might change our practice.

Personalised care for people with cancer

28 Apr 2022

This week's Pearl - in association with Macmillan Cancer Care - we are offering you a toolkit to share with your team to build on conversations about how you can implement personalised care for people with cancer. Watch our Bytes on this topic.

More info PDF

Personalised care for people with cancer

This week's Pearl - in association with Macmillan Cancer Care - we are offering you a toolkit to share with your team to build on conversations about how you can implement personalised care for people with cancer. Watch our Bytes on this topic.

Personalised care for people with cancer: How are you doing as a team?

It will come as no surprise that people living with cancer need support at the time of diagnosis and at key points in their treatment and beyond. Yet research, even prior to COVID, identified significant unmet need, particularly around financial, emotional and persistent physical symptom support.

The cancer care review and support phone call are now enshrined in QOF in England, and this care is just as important across the whole of the UK.

This week’s Pearl is a little different.

In association with Macmillan Cancer Support, we are offering you a toolkit to share with your team to build on conversations about how you can implement personalised care for people with cancer. In the article and Red Whale Byte video, we look at:

  • Why cancer care in primary care shouldn’t be like a conveyor belt.
  • How to do an efficient and effective cancer care review (even in these times of high workload).
  • How to identify unmet need.
  • How to develop the roles of ALL primary care team members, including nurses and social prescribing link workers, to support this important work.

Click here to view the Red Whale Bytes on ‘Personalised Care for people living with cancer’ and ‘Social prescribing for people living with cancer’. It is designed for the whole clinical team, so please share freely or maybe use it as a springboard for a PHCT or QI meeting?

We would love to hear your stories or examples of great practice in this area. Contact us at mail@red-whale.co.uk

All that itches – is it thrush?

21 Apr 2022

Join our Women’s Health team for this week’s Pearl around assessing and managing thrush. Watch our handy Red Whale Byte on Thrush

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All that itches – is it thrush?

Join our Women’s Health team for this week’s Pearl around assessing and managing thrush. Watch our handy Red Whale Byte on Thrush

This week important questions being addressed are:

  • Is this thrush? We should be particularly wary of diagnosing thrush in the postmenopausal woman!
  • Which treatments we should use.
  • What to do if symptoms don’t improve.
  • What if it is recurrent?

Looking for a knowledge boost in women’s health? Join Lucy and Helen for a half-day Menopause Update on Fri 20 May or a full-day Women’s Health Update on Wed 29 June.

Trigeminal Neuralgia

14 Apr 2022

Trigeminal neuralgia can be one of those ‘spot diagnoses’ that is satisfying to make; it is awful to live with, but up to 90% of sufferers can get meaningful pain relief from carbamazepine – although side-effects are common. Watch our Byte on trigeminal neuralgia.

More info PDF

Trigeminal Neuralgia

Trigeminal neuralgia can be one of those ‘spot diagnoses’ that is satisfying to make; it is awful to live with, but up to 90% of sufferers can get meaningful pain relief from carbamazepine – although side-effects are common. Watch our Byte on trigeminal neuralgia.

“I keep getting these awful electric shocks on the left side of my face. It’s the weirdest pain I’ve ever had!”

Trigeminal neuralgia can be one of those ‘spot diagnoses’ that is satisfying to make; it is awful to live with, but up to 90% of sufferers can get meaningful pain relief from carbamazepine – although side-effects are common.

NICE produced its first guideline on trigeminal neuralgia in 2019.

The key recommendation was that carbamazepine should be the first-line and ONLY treatment initiated in primary care. Trigeminal neuralgia does not respond to conventional painkillers, including opiates.

In this week’s Pearl, we consider the diagnosis, red flags and management of trigeminal neuralgia. Click PDF to read our article and watch our short video Byte on trigeminal neuralgia.

Bites: human, animal and insect

07 Apr 2022

As the weather warms up, Easter holidays arrive and people increase their outdoor activities, we are likely to see more bites on the telephone triage list or in minor illness slots.

More info PDF

Bites: human, animal and insect

As the weather warms up, Easter holidays arrive and people increase their outdoor activities, we are likely to see more bites on the telephone triage list or in minor illness slots.

This is probably an area where we have all overprescribed antibiotics in the past, so offers an opportunity to reduce prescribing and repeat consulting.

This week’s Pearl covers NICE guidance on human, animal and insect bites. We address:

  • Which bites are high risk?
  • When are antibiotics needed?
  • Which antibiotics should we choose?

Click PDF to read more.

Meeting ‘targets’ for FIT (faecal immunochemical testing)

31 Mar 2022

We have heard a lot about faecal immunochemical testing (FIT) over the past few years, and it has become a key part of colorectal cancer screening and triage of patients to access colonoscopy for investigation of lower GI symptoms. Watch our Byte on FIT testing.

More info PDF

Meeting ‘targets’ for FIT (faecal immunochemical testing)

We have heard a lot about faecal immunochemical testing (FIT) over the past few years, and it has become a key part of colorectal cancer screening and triage of patients to access colonoscopy for investigation of lower GI symptoms. Watch our Byte on FIT testing.

Wherever you work in the UK, you are likely to be doing more FIT tests. And, if you work in England, you may be getting to grips with the latest iteration of the PCN DES. One of the new indicators is:

‘CAN-10: Percentage of lower gastrointestinal 2 week wait cancer referrals accompanied by a faecal immunochemical test result with the result recorded either 7 days leading up to the referral or fourteen days after the referral’.

It is a good test.

But to use it to its best advantage it is helpful to understand how it works. This is the subject of this Cancer Pearl and key headlines are:

  • A negative FIT test through the national screening programme does not rule out cancer in a symptomatic person.
  • NICE updated its guidance on when we should do a FIT test in early 2021 – we should be doing more!
  • FIT has a role in triaging HIGH RISK people who already meet NG12 criteria for urgent referral.
  • It is not a perfect test – we need to safety net carefully and follow-up FIT-negative people who remain symptomatic.

You can explore this further in this week's Pearl - click PDF to read it.

Or, for a simple overview, watch this Red Whale Byte on FIT testing.

Visual aura of migraine…or something else?

24 Mar 2022

In this week’s Pearl, join us on the Red Whale sofa to consider how we might go about separating out symptoms that could be migraine or could be TIA.

More info PDF

Visual aura of migraine…or something else?

In this week’s Pearl, join us on the Red Whale sofa to consider how we might go about separating out symptoms that could be migraine or could be TIA.

This call is on your triage list:

“Mrs Khan (58 years old) – her vision went funny an hour ago and she doesn’t feel right. She thinks it might be a migraine but she’s not had one before.”

In this week’s Pearl, we'll consider how we might go about separating out symptoms that could be migraine or could be TIA using a framework to guide us that includes:

  • Types of symptoms.
  • Speed of onset.
  • Frequency.

Watch a 5-minute Red Whale Byte on separating out symptoms that could be migraine or could be TIA.

Click PDF to read our article.

For more engaging primary care education, from long-term conditions to red flags not-to-miss, and prescribing dilemmas and common conundrums that no one else will teach you about in quite the same way, join us for our new season of GP Update courses.

 

Spinal cord compression/cauda equina

17 Mar 2022

In primary and urgent care settings, we see a lot of back pain. We have talked in recent Red Whale courses about the ‘3Ns’ approach as a mental sieve to separate presentations into Nasty, Nerve irritation and Non-specific.

More info PDF

Spinal cord compression/cauda equina

In primary and urgent care settings, we see a lot of back pain. We have talked in recent Red Whale courses about the ‘3Ns’ approach as a mental sieve to separate presentations into Nasty, Nerve irritation and Non-specific.

In this week’s Pearl, we focus specifically on asking the right questions to pick up early spinal cord compression and cauda equina syndrome.

The classical textbook descriptions of saddle anaesthesia, weakness and motor signs, and incontinence are late signs.

Asking about earlier signs such as change of sensation when passing urine, change in erections or vaginal sensations may be more sensitive for early compression.

Click PDF to read more.

For more engaging primary care education, from long-term conditions to red flags not-to-miss, and prescribing dilemmas and common conundrums that no one else will teach you about in quite the same way, join us for our new season of GP Update courses.

Gynaecomastia

10 Mar 2022

Moobs (man-boobs) entered the English dictionary in 2016 but gynaecomastia is not a new issue. ‘Apparent’ gynaecomastia is increasing as the prevalence of obesity increases. Watch our video byte on gynaecomastia.

More info PDF

Gynaecomastia

Moobs (man-boobs) entered the English dictionary in 2016 but gynaecomastia is not a new issue. ‘Apparent’ gynaecomastia is increasing as the prevalence of obesity increases. Watch our video byte on gynaecomastia.

“I’ve got back on the bike, like you suggested. I’ve even lost 3kg, but the blokes are giving me a hard time about my moobs. Is there anything you can do?”

Gynaecomastia is important for 3 reasons:

  • As a marker of poor cardiometabolic health.
  • As a presenting feature of serious disease, e.g. liver disease, testicular tumours and endocrine disorders.
  • As a cause of psychological morbidity for some men that may contribute to mental health problems and eating disorders, particularly in adolescents.

 So, how should we approach these consultations?

This week’s Pearl reveals all – click PDF to read our article.

For more engaging primary care education, from long-term conditions to red flags not-to-miss, and prescribing dilemmas and common conundrums that no one else will teach you about in quite the same way, join us for our new season of Face to Face GP Update courses or the GP Update Together online.

Eating disorders

03 Mar 2022

The COVID-19 pandemic has had a particular impact on people with and at risk from eating disorders. The incidence has increased and it is harder to access timely help. Primary care has a really important role to play.

More info PDF

Eating disorders

The COVID-19 pandemic has had a particular impact on people with and at risk from eating disorders. The incidence has increased and it is harder to access timely help. Primary care has a really important role to play.

This week is Eating Disorders Awareness Week in the UK.

So, in this week’s Pearl, we share our article on eating disorders, particularly:

  • How to use the SCOFF tool to help with diagnosis.
  • Why early referral is important – we don’t have to wait for an underweight BMI.
  • Specific medical needs of people with eating disorders.

We will be covering this topic and lots more, including depression, anxiety, mental wellbeing with long COVID, supporting people with persistent physical symptoms and, perhaps most importantly, how to look after ourselves in our Mental Health Together course on Thur 10 Mar. Join Lee David on the Red Whale sofa from the comfort of your own home!

Depression in Older People

24 Feb 2022

Depression in older people is common but can be easily missed. How does depression present differently in older people? How should treatment differ in this group? Watch our Byte on Depression in Older People.

More info PDF

Depression in Older People

Depression in older people is common but can be easily missed. How does depression present differently in older people? How should treatment differ in this group? Watch our Byte on Depression in Older People.

In this weeks PEARL we consider:

  • How physical presentations, memory problems and anhedonia can be more common.
  • Tips on differentiating depression and dementia.
  • How treatment may differ and why we should be proactive about psychological therapies.

If you would like to explore some more important mental health topics, including how to look after yourself and your colleagues, join Lee David on the Red Whale sofa for our Mental Health Together event on Thur 10 March.

Obesity: the science and the landscape

17 Feb 2022

This week’s Pearl is a ‘long read’ about the evolving science around obesity and overweight.

More info PDF

Obesity: the science and the landscape

This week’s Pearl is a ‘long read’ about the evolving science around obesity and overweight.

Spoiler alert: this may be very different from what we learned at university. From genetics to environment, set-points to gut microbiota… we share all!

I’m sooo busy…should I bother?

Well, it might just change your thinking – it did ours!

Here are some of the headlines:

  • ‘Eat less, exercise more’ doesn’t work. It induces shame, which never helps anyone.
  • We are not well-placed to tackle population-level obesity – this is complex and requires political and system change to make a significant impact.
  • We ARE well-placed to help individuals, and this article will help us to:
    • Reframe conversations about obesity.
    • Redefine what success looks like.
    • Recognise the need for multi-professional support for complex obesity and, where we can, refer sooner.

So, to find out more, grab a cuppa and click PDF to read our Pearl.

All our fully-updated obesity articles can be found on GPCPD.com, along with more than 900 other primary care topics!

Sudden hearing loss in adults

10 Feb 2022

Sudden hearing loss can be an ‘otological emergency’. Get a 2-minute overview of sudden sensorineural hearing loss by taking a look at our Red Whale Byte.

More info PDF

Sudden hearing loss in adults

Sudden hearing loss can be an ‘otological emergency’. Get a 2-minute overview of sudden sensorineural hearing loss by taking a look at our Red Whale Byte.

Sudden hearing loss can easily get lost in the telephone triage list; ‘hearing problems’ doesn’t feel that urgent, does it?

This week’s Pearl reminds us, when seeing an adult with NEW hearing loss:

  • How to assess.
  • When to refer.
  • When to use steroids.
  • What to do if you can’t find your tuning fork!

Click PDF to read more in our Hearing loss GEMS.

Non-traumatic knee pain

03 Feb 2022

How confident are you at assessing non-traumatic knee pain? This week’s Pearl offers you a quick reminder about non-traumatic knee pain. Watch our video on this topic.

More info PDF

Non-traumatic knee pain

How confident are you at assessing non-traumatic knee pain? This week’s Pearl offers you a quick reminder about non-traumatic knee pain. Watch our video on this topic.

“I’ve been trying to do couch to 5k. It was going brilliantly but I’m now on week 5 and the outside of my knee is starting to hurt every time I run – help!”

What’s going on here? How confident are you at assessing non-traumatic knee pain? Many of us find this tricky. A quick and accurate diagnosis and appropriate management plan increase the chance that we help people to stay confident in keeping active.

Did you spot the most likely diagnosis?  This is probably ilotibial band friction syndrome – a really satisfying spot diagnosis! If this is new to you, you might enjoy this Red Whale Byte video clip.

And if you want to boost your confidence with a comprehensive overview of all things primary care MSK, why not join Mike and Giles on the Red Whale sofa on Thur 10 Feb for the MSK & Chronic Pain Together.

Click PDF to read our full Pearl.

BMI and ethnic groups

27 Jan 2022

This week we look at a recent study that quantifies the risk of diabetes in people of different ethnicities and consider how can we translate this new evidence this into action.

More info PDF

BMI and ethnic groups

This week we look at a recent study that quantifies the risk of diabetes in people of different ethnicities and consider how can we translate this new evidence this into action.

“Health inequalities are unfair and avoidable differences in health across the population, and between different groups in society. They arise because of the conditions in which we are born, grow, live, work and age” (NHS and PHE agreed definition). Tackling health inequalities requires government- and population-level action. But that doesn’t mean there is nothing we can do with individual patients – because health inequalities can also arise from outdated medical wisdom and an absence of evidence from across a wide range of different populations.

That is why we were excited to see and share this recent study that quantifies the risk of diabetes in people of different ethnicities.

Spoiler alert: over a median 6.5 years’ follow-up, people of South Asian ethnicity with a BMI of 23.9 had the equivalent risk of type 2 diabetes as a white person with a BMI of 30.

How can we translate this into action? Let’s consider this in more detail in this week’s Pearl - click PDF to read it.

Managing menopause after breast cancer

20 Jan 2022

Menopause has been such a hot topic in the past 12 months and the virtues of HRT have been extolled loudly by the media. HRT is the most effective treatment for menopausal symptoms but it cannot be used by all women, including many who have received treatment for breast cancer...

More info PDF

Managing menopause after breast cancer

Menopause has been such a hot topic in the past 12 months and the virtues of HRT have been extolled loudly by the media. HRT is the most effective treatment for menopausal symptoms but it cannot be used by all women, including many who have received treatment for breast cancer...

For all women, a holistic approach is needed. How do we best support women living with breast cancer who raise concerns about menopause symptoms?

In this Pearl, we look at treatment options in this specific group and address common conundrums such as:

  • Is HRT completely contraindicated?
  • Can vaginal oestrogens be used?
  • Which SSRIs interact with tamoxifen?

Click PDF to read our Pearl. You can learn more about the management of menopause on our half-day Menopause webinar on Fri 28 Jan.

Primary care superpowers can also be our kryptonite…

13 Jan 2022

Recognising our own strengths and needs is an essential part of sustaining ourselves. So, in this week’s Pearl, we meet 3 personality traits that many of us share: the chronic superhero, the perfectionist and imposter syndrome.

More info PDF

Primary care superpowers can also be our kryptonite…

Recognising our own strengths and needs is an essential part of sustaining ourselves. So, in this week’s Pearl, we meet 3 personality traits that many of us share: the chronic superhero, the perfectionist and imposter syndrome.

Superman sometimes had to rest and just be Clark Kent. In the same way, as primary care clinicians, we also need to rest and just be our ‘non-work selves’. We hope that Christmas offered an opportunity for this for many of you, and if not, that a break is round the corner.

At this time of new year’s resolutions, you might be thinking of how you can continue to sustain yourself in 2022. Recognising our own strengths and needs is an essential part of this.

In this week’s Pearl, we explore 3 personality traits that many of us share: the chronic superhero, the perfectionist and imposter syndrome. These form part of our superpowers, but unless we are aware, they can also be part of our downfall. Our mental health team considers how to harness them for good.

Follow this link if you would like to listen to our podcast Perfectionism, the chronic hero complex, imposter syndrome and other traits that hold us back 

And if you are struggling right now, you are not alone. Please ask for help. Follow this link for sources of support.

Childhood cancer

16 Dec 2021

Childhood cancer is more common than we think. An average GP will diagnose 1 case every 5–10 years. Watch our video on childhood cancer.

More info PDF

Childhood cancer

Childhood cancer is more common than we think. An average GP will diagnose 1 case every 5–10 years. Watch our video on childhood cancer.

Delayed diagnosis and the sense of having ‘missed a case’ has a huge impact on the child, their family and us as clinicians. This is even harder in the climate we currently work in.

And yet, children rarely present with ‘alarm symptoms’, and most children with cancer look well when they first present to primary care.

We need all our primary care flare to keep this diagnosis on our radar. To just ask…could this be? To be alert to parental concern. And to try, the best we can, to plug the gaps in continuity of care that exist for many of us.

Bottom line: the oldies are still important – trust your gut and consider the three-strikes-and-in rule?

Click PDF to read more in this week’s Pearl.

Bronchiolitis: There’s a lot of it about

09 Dec 2021

Bronchiolitis is usually a disease of the under-2s and is most common in the first year of life. But we are seeing more of it this winter, and in older infants who were not exposed last year because of COVID restrictions. Watch our video on bronchiolitis.

More info PDF

Bronchiolitis: There’s a lot of it about

Bronchiolitis is usually a disease of the under-2s and is most common in the first year of life. But we are seeing more of it this winter, and in older infants who were not exposed last year because of COVID restrictions. Watch our video on bronchiolitis.

Triage list: Olea, 14m, cough, breathing fast, wheezy, off food, worse over past 24h. Family did COVID PCR test yesterday – negative.

Bronchiolitis is a usually a self-limiting condition, but up to 3% of infants need admission for oxygen and feeding support! NICE has updated its guidance.

In this week’s video Pearl, taken from the current GP Update course, we cover how to spot and assess bronchiolitis, and how to decide which children need admission and which need oxygen while they are waiting for an ambulance.

Are you prepped to advise about PrEP?

02 Dec 2021

HIV transmission continues to fall across the UK, which is fantastic news. This is partly due to the availability of pre-exposure prophylaxis (PrEP) for HIV-negative people. PrEP is safe and effective.

More info PDF

Are you prepped to advise about PrEP?

HIV transmission continues to fall across the UK, which is fantastic news. This is partly due to the availability of pre-exposure prophylaxis (PrEP) for HIV-negative people. PrEP is safe and effective.

We cannot initiate this in primary care; if people request it, we should refer them on to sexual health services. But it is useful for us to understand who is eligible and may benefit, and how the different regimens work. An important note is that the majority of people who are on treatment for HIV will have completely suppressed viral loads, and their partners do NOT need to use PrEP for unprotected sex.

We are covering the diagnosis and primary care management of HIV on our GP Update courses at the moment, but let’s look at this specific issue in more detail in this week’s Pearl.

Raynaud's Phenomena

25 Nov 2021

As winter takes hold, one of the presentations we might see popping up is fingers turning white in the cold. At last, an easy consultation! We are thinking about Raynaud’s – but hang on… is this primary or secondary Raynaud’s?

More info PDF

Raynaud's Phenomena

As winter takes hold, one of the presentations we might see popping up is fingers turning white in the cold. At last, an easy consultation! We are thinking about Raynaud’s – but hang on… is this primary or secondary Raynaud’s?

Isn’t it great when you know exactly what is wrong with the patient from the story alone?! It doesn’t happen as often as we might like. A common winter presentation is fingers turning white in the cold. We are thinking about Raynaud’s but how do we know if it is primary or secondary Raynaud’s? What tests should we think about doing? And what treatments should we advise?

Our Pearl this week looks back at a 2016 NEJM review on this topic and summarises the bits relevant to primary care. Click PDF to read our article.

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