Welcome to the February 2022 issue of Guidelines in Practice, in which we have a focus on affairs of the heart with the publication of NICE’s first guideline on the investigation and management of heart valve disease. Dr Yassir Javaid highlights the significant unmet need in this area. Many who present with this underdiagnosed condition are elderly and, given the ageing population of the UK, a sharp increase in its prevalence can be expected in the next few decades. Although interventions are undertaken in secondary care, GPs have a significant role to play in identifying patients and referring them to cardiology services. Timely recognition is key to improving prognosis and avoiding progression to valvular heart failure. Dr Javaid’s comprehensive overview of the NICE recommendations outlines the causes, signs and symptoms, referral, and treatment of the condition.

From heart disease to a change of heart: Dr Vasumathy Sivarajasingam discusses the value of motivational interviewing (MI) techniques in supporting patients to make beneficial lifestyle and behavioural changes. Compliance with therapy is important for optimum management, and behavioural changes may be necessary to manage an existing condition or to prevent one from developing, but some patients are reluctant to change. Dr Sivarajasingam offers her tips on how MI can be integrated into routine practice in primary care. Motivating those patients who need to commit to a transformation is a central plank of successful treatment, as is averting the need for it in the first place.

Also in this issue: 

  • Dr George Moncrieff looks at the presentation, diagnosis, and treatment of psoriasis in children, providing tips on identification and management of comorbidities, assessment of severity, and personalisation of treatment
  • Professor David Halpin covers the 2022 Global Initiative for Chronic Obstructive Lung Disease report on chronic obstructive pulmonary disease, focusing on the key changes for primary care
  • in the View from the groundDr Murray Ellender explores the pressure on general practice, and its relationship to the number of patients overwhelming A&E departments.

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