Around this time of year it feels appropriate to stop and think about all that has been achieved over the last 12 months. As always, our priority has been covering new and updated clinical guidance, focusing on the aspects that are relevant to primary care. Throughout 2019, we have examined the role of the clinical pharmacist in general practice, to try and reflect the increasing presence of this group of professionals in primary care. We have featured articles covering the role of the pharmacist in type 2 diabetes, asthma, prescribing, eczema, hypertension, psoriasis, frailty and polypharmacy, and lastly, frailty in malnutrition (in this issue—read more below). We have also continued to explore different topics through our popular Top tips and Differential diagnoses articles, one of each of which is included in this issue.

One important new guideline is that on antimicrobial prescribing for community-acquired pneumonia, published by NICE in September 2019. Inappropriate prescribing of antibiotics for respiratory tract infections is common in general practice. The guideline aims to optimise antibiotic use and reduce antibiotic resistance by encouraging the prescribing of narrow-spectrum antibiotics, and for a limited course length regardless of the severity of pneumonia. Dr Caroline Ward highlights the recommendations for primary care, including the use of CRB65 score to assess severity of pneumonia in adults, using clinical judgement to inform referral decisions, and knowing when to prescribe antibiotics. There is also a set of patient scenarios designed to help you reflect on how you would manage different cases in line with the updated guidance.


Key learning points: NICE community-acquired pneumonia

Image source: © James Cavallini/Science Photo Library

Dr Caroline Ward

Unintentional weight loss is an important symptom with a range of physiological and psychological explanations. Dr Sonya Jey unpicks some hypothetical case studies in which weight loss is an incidental feature, and reveals some common and some sinister causes. For each case study, Dr Jey explains the diagnosis, highlights the appropriate management strategy, and identifies red flags for referral where appropriate.

The World Health Organization (WHO) has recently reported on a surge in the number of cases of measles worldwide. The UK achieved WHO measles elimination status in 2017, but since then, the number of cases has been on the rise because of a decline in vaccination uptake. In the Top tips article Dr Toni Hazell dispels myths about associations between the MMR vaccine and autism, and provides tips for GPs on managing parents and carers who are sceptical about vaccinating their children. Dr Hazell also touches on the need for certain vaccinations in pregnancy to protect the mother and unborn child.

Frailty and malnutrition often coexist and can exacerbate each other—although the health implications can be significant, frailty is not inevitable, and malnutrition is a modifiable factor. Shailen Rao and Samantha Cudby discuss the role of the pharmacist in screening for malnutrition in frail older patients and managing those at risk of malnutrition, including prescribing and reviewing use of oral nutritional supplements.

Guidelines Live is another success from this year that we are already reminiscing about, despite it being just 1 month ago: in this issue we review the best bits from the most popular streams. 

Looking ahead to next year, there is a lot of guidance coming out that we are planning to cover (asthma, colorectal cancer, and chronic pain, to name a few). We are also planning to put two very different but important health issues in the spotlight: antimicrobial prescribing and mental health. 

If you have any suggestions for topics you would like to see covered in Guidelines in Practice, please get in touch via Twitter or at the email address below.

Gemma Lambert, Editor