Guidelines Live virtual event was a great success—what were the best bits from the most popular clinical streams?
Keynote–The importance of guidelines in the context of COVID-19
Day one started with the keynote session from Professor Gillian Leng, NICE’s Chief executive, who demonstrated how NICE had responded to the onset of the COVID-19 pandemic, by putting itself at the forefront of a new series of rapid guidelines to enable faster treatments for patients. Learning from the experiences of guideline development during COVID-19, Professor Gillian Leng, ended by describing her vision for NICE’s work in the future.
"Very helpful practical information with new found confidence re managing in primary care thank you!"
Dermatology—PCDS eczema pathway
The clinical sessions started with the dermatology stream and an engaging presentation from Julie Van Onselen. This presentation outlined the Primary Care Dermatology Society (PCDS) guidance for the management of eczema in primary care. Julie began by providing an overview of eczema, with a focus on atopic eczema, including the aetiology of atopic eczema (immunology, genetic factors, and environmental triggers).
She described how to take an accurate clinical history, what the assessment should include, and how the signs and symptoms of eczema can differ across skin types. She also discussed the stepwise treatment recommended by the PCDS—each of these steps, including initial flare and long-term management, were illustrated by a dynamic case study looking at the different stages of the condition. Julie also highlighted the importance of holistic care and psychological support and gave tips on how to conduct a virtual eczema consultation.
Ear, nose, and throat—common ear conditions
Diabetes–pharmacological management of type 2 diabetes in primary care
Recent developments in the medications for type 2 diabetes alongside new evidence from cardiovascular outcome trials have meant that recommendations and guidelines for managing patients with type 2 diabetes are constantly being revised. However, the NICE guideline on type 2 diabetes has seen only minor revisions since 2015, so there has been increasing uptake of more up-to-date guidelines, such as the American and European guidelines. Primary Care Diabetes Europe (PCDE) has recently published recommendations for the pharmacological management of type 2 diabetes.
The aim Dr Amar Puttanna’s session was to explain the background to the PCDE guideline, and provide details of the recommendations about the available therapeutic options. Amar engaged audience members by illustrating the rationale behind the recommendations, and the importance and impact of early achievement of glycaemic targets. He also mentioned the consideration of cardiovascular risk in those with type 2 diabetes, and considerations for early combination therapy. He also discussed stratifying management depending on ‘at risk’ groups with co-existing conditions, such as those with cardiovascular disease, heart failure, obesity, and frailty.
Cardiovascular—cardiovascular disease and hypertension
Day two began with the second cardiovascular stream of the event and included a session on cardiovascular disease (CVD) and hypertension presented by Dr Matt Fay. Matt summarised key points from the relevant NICE guidelines, and described how the recommendations can be applied pragmatically in current practice. Cardiovascular disease is at the centre of public health prevention agenda through the A-B-C initiative, which focuses on atrial fibrillation, blood pressure, and cholesterol.
One of the most significant modifiable risk factors for CVD is high blood pressure, but case finding is challenging as it is often asymptomatic. The session looked at blood pressure as one of the factors in cardiovascular risk, how to assess the risk it poses, and how normal practice may need to be modified in a time of reduced patient contact during the COVID-19 era.
"Superb presentation, loads of information and ideas for quality improvement. I have even just ordered my own home bp monitor!"
COPD–managing COPD in the COVID-19 era
Dr Kevin Gruffydd-Jones’ very topical session explained how remote routine review of patients with chronic obstructive pulmonary disease (COPD) can be carried out in primary care, during the COVID-19 pandemic, despite the difficulties in measuring lung function. Specifically, delegates were made aware of the following points:
assessment of symptomatic control can be carried out using the COPD assessment tool and Medical Research Council dyspnoea score. Exacerbation history is a key determinant of future risk of exacerbations. Remote review should be used to reinforce smoking cessation advice and reinforce a personalised action plan
If symptomatic control is poor, there should be a low threshold to carry out a face-to-face review in view of the high risk of significant respiratory and non-respiratory co-morbidity causing symptomatic deterioration
non-pharmacological management is key to optimal COPD control. Regular dual inhaled bronchodilator therapy is the cornerstone of pharmacological therapy, with inhaled corticosteroid treatment reserved for patients with asthma overlap features, significant blood eosinophilia and/or patients with recurrent exacerbations.
Guidelines Live 2020 on demand
We would like to thank all of our speakers and attendees who contributed and made the Guidelines Live 2020 virtual event so successful. All sessions are now available on demand here.