Once again at this year’s NICE conference it was highlighted that evidence-based guidance only ensures best practice and equitable care if it is implemented. One of our main aims with Guidelines in Practice is to support you with implementing national guidance at a local level. To this end we regularly feature articles, often written by guideline development group members, focusing on guidelines and how they should be put into practice in primary care, and the specific barriers and challenges that may be encountered through their implementation.

Previously, these articles have been categorised under ‘New guideline’, ‘Updated guideline’, or ‘Guideline revisited’ headings, but this is changing. From this issue, all articles that focus on implementing guidance will be categorised as exactly that: ‘Implementing guidance’. What’s more, this issue contains a bumper crop of ‘Implementing guidance’ articles, covering erectile dysfunction (ED), Lyme disease, and attention deficit hyperactivity disorder (ADHD), each described in more detail below.

The British Society for Sexual Medicine updated its guideline on the management of erectile dysfunction in April 2018. Guideline development group members Professor Geoff Hackett and Professor Mike Kirby summarise the recommendations on diagnosing and treating ED in primary care, highlighting that it is an important indicator of cardiovascular disease as well as other conditions, including diabetes. As such, men presenting to primary care with ED should be assessed for cardiovascular and endocrine risk factors (which should be managed appropriately), while men attending primary care with chronic cardiovascular disease should be asked about erectile problems.

Pharmacists also play an important role in assessing associated co-morbidities to ensure safe and appropriate dispensing, identifying and excluding inappropriate use of medications, and signposting where further investigations are required. Read the article and then test your updated knowledge using the related multiple-choice questions in this issue.

penis blood vessels

Erectile dysfunction is an important marker for cardiovascular disease

Professor Geoff Hackett and Professor Mike Kirby

Summer is a great time to get outdoors so it is not unusual to see more people participating in outdoor pursuits, such as gardening, walking, running, or camping, at this time of year. The bacteria that cause Lyme disease are transmitted by the bite of an infected tick, and ticks are more commonly found in grassy and wooded areas, meaning that those who take part in outdoor activities are at increased risk. In April 2018, NICE published a new guideline on Lyme disease aimed at helping practitioners to diagnose Lyme disease early and start treatment promptly.

Dr Caroline Rayment, member of the guideline development group, describes how a tick should be removed, specific symptoms to look out for, tests that can help confirm a diagnosis, and what treatments to use and when. The article includes some helpful images showing the different presentations of an erythema migrans rash, as well as an algorithm showing the laboratory investigations and diagnosis for Lyme disease. 

Attention deficit hyperactivity disorder is characterised by symptoms of hyperactivity, impulsivity, and inattention, and if left undiagnosed or inappropriately treated, ADHD can have a significant adverse impact on a person’s quality of life. Diagnosis is made and treatment is initiated by an ADHD specialist; however, GPs are involved with identifying, and recognising ADHD symptoms and referring appropriately, as well as review and follow up of people with a confirmed ADHD diagnosis. Dr Natasha Halliwell discusses new recommendations from the updated NICE guideline, which provide some much needed clarity on the role of GPs in managing people with ADHD.

Our top tips articles provide evidence-based, practical tips to help you to quickly update your knowledge in a range of clinical areas. This month’s top tips article is on anaemia in adults. Dr Toni Hazell describes common causes of anaemia, diagnostic criteria, and possible differential diagnoses, and provides tips on history taking, appropriate investigations, and the management of iron deficiency anaemia using iron supplementation. For our full range of top tips articles visit: GinP.co.uk/top-tips