NHS FORTH VALLEY B12 and Folate: A Practical Guide
|
|
- Augustine Hodges
- 7 years ago
- Views:
Transcription
1 NHS FORTH VALLEY B12 and Folate: A Practical Guide Date of First Issue 27/05/2011 Approved 28/06/2011 Current Issue Date 24/06/2013 Review Date 24/06/2015 Version 1.0 EQIA 27/05/2011 Author / Contact Group Committee Final Approval Dr Roddy Neilson Primary Care Prescribing Group 28/06/2011 Laboratory Clinical Governance Group 22/06/2011 This document can, on request, be made available in alternative formats Version th May 2011 Page 1 of 6
2 NHS Forth Valley Consultation and Change Record Contributing Authors: Consultation Process: Dr Lucy Munro, GP Principal and Associate Advisor (cpd) in consultation with: Dr Roddy Neilson Consultant Haematologist Dr Chris Brammer Consultant Haematologist, Dr Gillian McLean Consultant Psychiatrist, Dr Chris Neumann Consultant Neurologist, Dr Peter Bramley Consultant Gastroenterologist Development was supported by NHS FV Quality Improvement Services This guide was written with significant input from Drs Neilson and Brammer Consultant Haematologists and drew heavily from the Laboratory Handbook. Dr G McLean Consultant in Old Age Psychiatry, Dr C Neumann, Consultant Neurologist and Dr P Bramley, Consultant Gastroenterologist also provided input and agreed the final version. Dr Leslie Cruickshank Prescribing Advisor was consulted. Pharmacy has also been consulted. Distribution: All GP practices to be sent hard copies in the Whole Systems Working Folder Change Record Date Author Change Version Version th May 2011 Page 2 of 6
3 B12 AND FOLATE: A Practical Guide The main reasons to test B12 and Folate levels are; Neuropsychiatric symptoms where the cause is not known; B12 deficiency is a rare cause of peripheral neuropathy, dementia, myelopathy and can cause sub acute combined degeneration of the spinal cord Macrocytosis (MCV > 100) or Macrocytic Anaemia; in pregnancy/while taking COCP an MCV up to 105 is usually a normal finding and does not require investigation Testing Other circumstances where higher vigilance is needed and testing of B12 and Folate assays may be indicated; Previous gastric surgery /Inflammatory Bowel Disease/Coeliac Disease these patients are at higher risk of B12 and Folate deficiency and may require B12 and Folate testing particularly if their symptoms are severe/there is a macrocytosis or anaemia/there are neuropsychiatric symptoms although remember azathioprene and mecaptopurine can both cause macrocytosis Iron deficiency anaemia not responding to adequate oral iron in a simple iron deficiency anaemia a rise of in HB 1g/dl/wk or 2g/dl/3 wks would be expected, B12 and folate deficiency are possible although rare causes of failure to respond to oral iron Circumstances NOT to check B12 and Folate levels; o There is no value in re-testing B12 levels in patients who are already on parenteral vitamin B12, when required, use FBC to monitor response to B12 injections o Some medications, such as metformin and COCP, can reduce B12 absorption but taking these medications is not of itself an indication to check B12/folate levels o Non specific tiredness is not an indication to check B12/Folate levels in the absence of other indications Interpreting the results B12 Management of B12 results B12 <120 is not normal, it is low and most likely to be pathologically low warranting further investigation (severe dietary deficiency can sometimes occur to this level in longstanding dementia patients and vegans) B is borderline and management will depend upon the clinical situation B12 > 180 is normal B12 < 120: this is low Check Anti Intrinsic Factor antibodies PRIOR to treatment Anti-IF antibodies are diagnostic of Pernicious Anaemia Schilling tests are no longer available and anti gastric parietal cell antibodies are non specific and non diagnostic Negative Anti-IF antibodies does not exclude Pernicious Anaemia and in the absence of history or examination findings suggestive of terminal illeal disease or another cause of B12 deficiency a presumptive diagnosis of Pernicious Anaemia can be made The diagnosis of Pernicious Anaemia means that the patient will require lifelong treatment with parenteral B12 Dietary deficiency can occasionally cause levels this low but only when the diet is deficient in B12 over a prolonged period such as in dementia or veganism. Take a dietary history. B : this is a borderline result Check Anti-IF antibodies PRIOR to treatment Anti-IF antibodies are diagnostic of Pernicious Anaemia Otherwise management of B12 at these levels is dependent upon the clinical situation. It is a normal finding in some patients Use Clinical judgement depending upon the situation Consider the patient s clinical situation: Examples o Does the patient have myelopathy/peripheral neuropathy? Treat pragmatically with parenteral B12 o Does the patient have dementia? It is most likely that the deficiency is dietary and can be very severe depending upon the length of time the patient s diet has been sufficiently poor. Unless the patient has Pernicious Anaemia the aim is the return to a better nutritional status rather than defaulting to lifelong B12 injections. The evidence suggests that replacement of B12 does NOT reverse cognitive impairment but a return to a better general nutritional status is best practice. Short term B12 injections may be needed Version th May 2011 Page 3 of 6
4 Treatment for B12 deficiency o Is the patient anaemic with a macrocytosis? treat pragmatically with B12 o Take a dietary history. Is the patient a vegan? Oral B12 replacement (SLS) may be needed. o Does the patient have symptoms suggestive of terminal illeal disease? These patients may require onward referral o Does the patient have other auto immune disorders or a strong family history of auto immune disorders? > consider watchful waiting/monitoring of B12 levels 6 monthly B12 >180: this is normal, no action required What and how? The treatment for Pernicious Anaemia is parenteral B12 (Hydroxocobalamin) (patients with Pernicious Anaemia cannot absorb oral B12) Oral B12 (Cyanocobalamin) replacement is not well absorbed in ANY patient and as such requires very large doses In those with dietary deficiency, return to normal nutritional status is preferable where possible. Short term parenteral B12 may be needed in patients with dementia. The evidence for the use of oral B12 is not clear but is likely to have a place in ongoing dietary deficiency e.g. veganism (script should be marked SLS) Parenteral B12 is often the default treatment option because not all PA can be confirmed. See below for advice on additional folic acid replacement How often? The BNF loading schedule for B12 should be followed and patients should then be given B12 injections 3 monthly If there are neurological features present then the situation is different; the BNF loading schedule should be followed then B12 should be given every 2 months In the absence of neurological features or anaemia there is no value to administering parenteral B12 injections any more often than 3 monthly. For those occasional who wish to have more frequent B12 injections this is not driven by low B12 levels. There is no value in re testing B12 levels in those already receiving parenteral B12, monitoring can be done with FBC alone. Serum folic acid assays reflect recent dietary habits. Red Cell Folate is a more reliable indicator of the actual total body folate status but a considerably more difficult to test to do and as such is reserved for those with borderline serum folate results. The Role of Folate Diet is the commonest cause of low folate levels and a six week course of folic acid is the most appropriate course of action in the first instance. Ideally thereafter dietary correction should take place. If there are symptoms suggestive of small bowel disease or if there is a poor response to oral folate then further investigation for small bowel disease is required. Secondary folate deficiency is often seen as a consequence of B12 deficiency in this situation patients often require folic acid and B12. Moderate B12 deficiency may occur secondary to severe folate deficiency B12 replacement in this situation may only be needed until folate stores are repleted When to refer/discuss with Secondary Care Haematology: Failure to respond to therapy. Some haematological problems such as myelodysplasia may present in a similar fashion to pernicious anaemia and as such if there is a failure to respond to B12 therapy i.e. there is not a prompt rise in HB. This situation should be discussed with a haematology consultant Gastroenterology: Suspected malabsorption/terminal illeal disease, consider discussion with or referral to gastroenterology Neurology: If there is a peripheral neuropathy which fails to respond to standard treatments, consider discussion with or referral to neurology Dementia: B12 deficiency usually has a dietary cause in patients dementia but parenteral B12 may be required if there is anaemia, pernicious anaemia or neurological symptoms. Version th May 2011 Page 4 of 6
5 Resources Haematology & Blood Transfusion Laboratory Handbook, Forth Valley. Oral vitamin B12 versus intramuscular vitamin B12 for vitamin B12 deficiency. Cochrane Library Vitamin B12 for cognition. Malouf R, Areosa Sastre A. Cochrane Library 2003 NHS Clinical Knowledge Summaries Clinical topic - Anaemia - B12 and folate deficiency BNF March 2011 Version th May 2011 Page 5 of 6
6 Publications in Alternative Formats NHS Forth Valley is happy to consider requests for publications in other language or formats such as large print. To request another language for a patient, please contact For other formats contact , text , fax or - fv-uhb.nhsfv-alternativeformats@nhs.net Version th May 2011 Page 6 of 6
Information for Clinicians
Information for Clinicians Guidelines for the Investigation & Management of vitamin B12 deficiency Background We frequently get asked for advice on the cause of a patient s vitamin B12 (cobalamin) deficiency
More informationGuidelines for the Investigation and Management of Vitamin B12 and Folate Deficiency
Hull and East Riding Prescribing Committee Guidelines for the Investigation and Management of Vitamin B12 and Folate Deficiency Developed by:, Hull & East Yorkshire Hospital NHS Trust Hull and East Riding
More informationLocal Coverage Determination (LCD): Vitamin B 12 Injection (L33502)
Local Coverage Determination (LCD): Vitamin B 12 Injection (L33502) Contractor Name Noridian Administrative Services, LLC LCD Information Document Information LCD ID L33502 LCD Title Vitamin B 12 Injection
More informationPACKAGE LEAFLET: INFORMATION FOR THE USER. VITAMINE B12 STEROP 1mg/1ml Solution for injection / oral solution. Cyanocobalamin
PACKAGE LEAFLET: INFORMATION FOR THE USER VITAMINE B12 STEROP 1mg/1ml Solution for injection / oral solution Cyanocobalamin Read all of this leaflet carefully before you start using this medicine because
More informationRDW-- Interpreting the Full Blood Count
RDW-- Interpreting the Full Blood Count The most important components of a Full Blood Count report are, of course, the Haemoglobin, the White Cell Count and Differential and the Platelet Count. However,
More informationSaskatchewan Drug Information Services College of Pharmacy and Nutrition, U of S T: (306)966-6340 F:(306)966-2286 www.usask.
Saskatchewan Drug Information Services College of Pharmacy and Nutrition, U of S T: (306)966-6340 F:(306)966-2286 www.usask.ca/druginfo Volume 19, Issue No. 2 March-April, 2002 TO P.O. B 12 OR NOT TO P.O.
More informationGP Guidance: Management of nutrition following bariatric surgery
GP Guidance: Management of nutrition following bariatric surgery Introduction Patients who are morbidly obese will have struggled with their weight for many years before going forward for bariatric surgery.
More informationNICE guideline Published: 2 September 2015 nice.org.uk/guidance/ng20
Coeliac disease: recognition, assessment and management NICE guideline Published: 2 September 2015 nice.org.uk/guidance/ng20 NICE 2015. All rights reserved. Contents Key priorities for implementation...
More informationCare Pathway for the Administration of Intravenous Iron Sucrose (Venofer )
Departments of Haematology, Nephrology and Pharmacy Care Pathway for the Administration of Intravenous Iron Sucrose (Venofer ) [Care Pathway Review Date] Guidance for use This Care Pathway is intended
More informationEFFECT OF DAILY VERSUS WEEKLY IRON FOLIC ACID SUPPLEMENTATION ON THE HAEMOGLOBIN LEVELS OF CHILDREN 6 TO 36 MONTHS OF URBAN SLUMS OF VADODARA
ORIGINAL ARTICLE. EFFECT OF DAILY VERSUS WEEKLY IRON FOLIC ACID SUPPLEMENTATION ON THE HAEMOGLOBIN LEVELS OF CHILDREN 6 TO 36 MONTHS OF URBAN SLUMS OF VADODARA K Sharma 1, P Parikh 2, F Desai 3 1 PhD Advisor,
More informationNutrition After Weight Loss Surgery
Nutrition After Weight Loss Surgery Gastric Bypass Sleeve Gastrectomy Gastric Banding VITAMINS AND MINERALS AFTER SURGERY TEXAS CENTER FOR MEDICAL & SURGICAL WEIGHT LOSS What We ll Cover Today Why do I
More informationB12 & Cobalamin. Learning objectives
Learning objectives B12 & Cobalamin Define vitamins Classify fat soluble and water soluble vitamins. Study chemical structure and biological active coenzyme form of vitamin B12. List the dietary sources
More information45813E/Revised: April 2008 CYANOCOBALAMIN INJECTION, USP
45813E/Revised: April 2008 CYANOCOBALAMIN INJECTION, USP DESCRIPTION: Cyanocobalamin Injection, USP is a sterile solution of cyanocobalamin for intramuscular or subcutaneous use. Each ml contains 1000
More informationThe Blood Budget: how can we reduce costs and influence best practice? Sue Redfearn Blood Transfusion Manager Poole Hospital NHS Foundation Trust
The Blood Budget: how can we reduce costs and influence best practice? Sue Redfearn Blood Transfusion Manager Poole Hospital NHS Foundation Trust Poole Hospital vital statistics 680 beds 2011 (reduced
More informationMANAGEMENT OF DIRECT ANTIGLOBULIN TEST (DAT) POSITIVE INFANTS NEONATAL CLINICAL GUIDELINE
MANAGEMENT OF DIRECT ANTIGLOBULIN TEST (DAT) POSITIVE INFANTS NEONATAL CLINICAL GUIDELINE 1. Aim/Purpose of this Guideline 1.1. To provide monitoring and treatment guidance for medical and nursing staff
More informationRheumatoid Arthritis. GP workshop 15 January 2011
Rheumatoid Arthritis GP workshop 15 January 2011 Case 1 A 72 year old Malay woman with RA comes for routine follow up. She feels generally unwell in the last 5 days. Appetite is fair. Her joints are fine.
More informationF r e q u e n t l y As k e d Qu e s t i o n s
page 1 Folic Acid Q: What is folic acid? A: Folic (FOH-lik) acid is a B vitamin. It helps the body make healthy new cells. Folic acid and folate mean the same thing. Folic acid is a manmade form of folate.
More information1.5 Function of analyte For albumin, see separate entry. The immunoglobulins are components of the humoral arm of the immune system.
Total protein (serum, plasma) 1 Name and description of analyte 1.1 Name of analyte Total protein 1.2 Alternative names None 1.3 NMLC code 1.4 Description of analyte This is a quantitative measurement
More informationGuidelines for the diagnosis and treatment of Cobalamin and Folate disorders
Guidelines for the diagnosis and treatment of Cobalamin and Folate disorders Vinod Devalia 1, Malcolm S Hamilton 2, and Anne M Molloy 3 on behalf of the British Committee for Standards in Haematology 1
More informationLaboratory Monitoring of Adult Hospital Patients Receiving Parenteral Nutrition
Laboratory Monitoring of Adult Hospital Patients Receiving Parenteral Nutrition Copy 1 Location of copies Web based only The following guideline is for use by medical staff caring for the patient and members
More informationNHS GGC Vitamin D Supplementation Frequently asked Questions
Pharmacy & Prescribing Support Unit NHS GGC Vitamin D Supplementation Frequently asked Questions In February 2012 the Scottish Government issued advice on supplements for groups at risk of vitamin D deficiency.
More informationDiet and Arthritis. Dr Áine O Connor Nutrition Scientist. British Nutrition Foundation. 2011 The British Nutrition Foundation
Diet and Arthritis Dr Áine O Connor Nutrition Scientist British Nutrition Foundation Outline Background What is arthritis? What are the common forms? Body weight and arthritis Diet and arthritis Nutrients
More informationAnemia and chronic kidney disease
Anemia and chronic kidney disease THE KIDNEY FOUNDATION OF CANADA 1 Anemia and chronic kidney disease What is anemia? Anemia is a condition in which the red cells in the blood are at a low level. The red
More informationHow to evaluate vitamin and iron deficiency in practice?
How to evaluate vitamin and iron deficiency in practice? Y Beguin University of Liège Belgium COI DECLARATION Advisory board : Vifor, Pharmacosmos, Amgen Speakers bureau : Vifor, Amgen Consultant : Amgen,
More informationTen top tips for the management of patients post bariatric surgery in primary care
Ten top tips for the management of patients post bariatric surgery in primary care Obesity is recognised as a major health and economic issue for the NHS. The rate of severe obesity with BMI >40 is increasing
More informationThe Spine Center at Beth Israel Deaconess
Spinal Pain The Spine Center at Beth Israel Deaconess Medical Center developed the following detailed eplanation of our care pathways for primary care providers to help support your interactions with patients
More informationSteps to getting a diagnosis: Finding out if it s Alzheimer s Disease.
Steps to getting a diagnosis: Finding out if it s Alzheimer s Disease. Memory loss and changes in mood and behavior are some signs that you or a family member may have Alzheimer s disease. If you have
More informationLaboratory Studies in the Diagnosis of Iron Deficiency, Latent Iron Deficiency and Iron Deficient Erythropoiesis
Laboratory Studies in the Diagnosis of Iron Deficiency, Latent Iron Deficiency and Iron Deficient Erythropoiesis General Comments The laboratory studies listed below are helpful in the diagnosis and management
More informationRivaroxaban: Prescribing Guidance for the treatment of provoked venous thromboembolism (VTE)
Rivaroxaban: Prescribing Guidance for the treatment of provoked venous thromboembolism (VTE) Amber Drug Level 2 Leeds We have started your patient on rivaroxaban for the treatment of provoked VTE (deep
More informationLocal Coverage Determination (LCD): Vitamin B 12 Injections (L30145) Contractor Information
Local Coverage Determination (LCD): Vitamin B 12 Injections (L30145) Contractor Information Contractor Name Wisconsin Physicians Service Insurance Corporation Document Information LCD ID L30145 LCD Title
More informationoptimal use of thyroid function tests (TFTs) to diagnose and monitor thyroid disease.
Guidance for Thyroid Function Testing in Primary Care in Lothian In July 2006 following a lengthy consultation process, a joint working group comprising representatives from the Association of Clinical
More informationPREOPERATIVE MANAGEMENT FOR BARIATRIC PATIENTS. Adrienne R. Gomez, MD Bariatric Physician St. Vincent Bariatric Center of Excellence
PREOPERATIVE MANAGEMENT FOR BARIATRIC PATIENTS Adrienne R. Gomez, MD Bariatric Physician St. Vincent Bariatric Center of Excellence BARIATRIC SURGERY Over 200,000 bariatric surgical procedures are performed
More informationVitamin B12 (cobalamin) plays
Vitamin B 12 Deficiency ROBERT C OH, CPT, MC, USA, US Army Health Clinic, Darmstadt, Germany DAVID L BROWN, MAJ, MC, USA, Madigan Army Medical Center, Fort Lewis, Washington Vitamin B 12 (cobalamin) deficiency
More informationNHS FORTH VALLEY Guidelines for Hepatitis B Vaccination in High Risk Groups
NHS FORTH VALLEY Guidelines for Hepatitis B Vaccination in High Risk Groups Approved 01/04/2012 Version 1.0 Date of First Issue 01/04/2012 Review Date 01/02/2014 Date of Issue 01/04/2012 EQIA Yes Author
More informationBeaumont Hospital Department of Nephrology and Renal Nursing. Guideline for administering Ferinject
Beaumont Hospital Department of Nephrology and Renal Nursing Guideline Name: Guideline for administering Ferinject Guideline Number: 18 Guideline Version: a Developed By: Louise Kelly CNM 1 Renal Day Care
More informationVITAMIN D PRODUCTS -WHAT AND WHEN TO PRESCRIBE. Claudette Allerdyce Principal Pharmacist Croydon CCG Pharmacy Team
VITAMIN D PRODUCTS -WHAT AND WHEN TO PRESCRIBE Claudette Allerdyce Principal Pharmacist Croydon CCG Pharmacy Team WHAT ARE THE ISSUES? A lack of suitable licensed vitamin D products in the UK for treating
More informationIRON METABOLISM DISORDERS
IRON METABOLISM DISORDERS ANEMIA Definition Decrease in the number of circulating red blood cells Most common hematologic disorder by Most common hematologic disorder by far 1 Blood loss ANEMIA Causes
More informationOFFICE OF THE STATE CORONER FINDINGS OF INVESTIGATION
OFFICE OF THE STATE CORONER FINDINGS OF INVESTIGATION CITATION: TITLE OF COURT: JURISDICTION: Non-inquest findings into the death of Mr B Coroner s Court Brisbane DATE: 29 February 2016 FILE NO(s): 2015/1036
More informationCareers in Haematology
Careers in Haematology A Guide for Medical Students and Junior Doctors Haematology is the medical speciality concerned with blood disorders. Your non-medical friends however will always think that you
More informationMyeloma pathways to diagnosis UCLP audit
Myeloma pathways to diagnosis UCLP audit Dr Neil Rabin Consultant Haematologist University College London Hospitals & North Middlesex University Hospital Myeloma Clinical Features Bone pain (70%) High
More informationThe diagnosis of dementia for people living in care homes. Frequently Asked Questions by GPs
The diagnosis of dementia for people living in care homes Frequently Asked Questions by GPs A discussion document jointly prepared by Maggie Keeble, GP with special interest in palliative care and older
More informationClinical Guideline N/A. November 2013
State if the document is a Trust Policy/Procedure or a Clinical Guideline Clinical Guideline Document Title: Document Number 352 Version Number 1 Name and date and version number of previous document (if
More informationThe Role of the Haematology Specialist Nurse. Catherine Chapman RN. BSc (Hons)
The Role of the Haematology Specialist Nurse Catherine Chapman RN. BSc (Hons) Key Roles Information Support Advice Patient advocate Education Coordination of care Information Patient Family Carers Health
More informationMS Treatments Aubagio TM
1 MSology Essentials Series Aubagio TM (teriflunomide) Developed by MSology with the invaluable assistance of multiple sclerosis nurse advisors: Bonnie Blain Central Alberta MS Clinic, Red Deer, Alberta
More informationProtocol for the safe administration of iodinated contrast media in diagnostic radiology
Protocol for the safe administration of iodinated contrast media in diagnostic radiology Protocol statement: This protocol applies to all staff within Radiology Departments at Heart of England NHS Foundation
More informationHealth Professionals who Support People Living with Dementia
Clinical Access and Redesign Unit Health Professionals who Support People Living with Dementia (in alphabetical order) Health Professional Description Role in care of people with dementia Dieticians and
More informationRELAPSE MANAGEMENT. Pauline Shaw MS Nurse Specialist 25 th June 2010
RELAPSE MANAGEMENT Pauline Shaw MS Nurse Specialist 25 th June 2010 AIMS OF SESSION Relapsing/Remitting MS Definition of relapse/relapse rate Relapse Management NICE Guidelines Regional Clinical Guidelines
More informationA guide for adults with. Intestinal. Dysmotility
A guide for adults with Intestinal Dysmotility This leaflet contains information for patients with dysmotility of the gut and discusses symptoms and management. page 2 Contents Introduction 4 Symptoms
More informationWomen, Children and Sexual Health Division Maternity Services. Guideline: Anti D- Prophylaxis
Women, Children and Sexual Health Division Maternity Services Guideline: Anti D- Prophylaxis 1. Introduction The National Institute for Clinical Excellence recommend routine antenatal anti-d prophylaxis
More informationQS114. NICE quality standard for irritable bowel syndrome in adults (QS114)
NICE quality standard for irritable bowel syndrome in adults (QS114) QS114 NICE approved the reproduction of its content for this booklet. The production of this booklet is sponsored by Thermo Fisher Scientific,
More informationProtocol for excluding B12 deficiency (Megaloblastic anemia/ Pernicious Anaemia) from adult and child patient presentation
Protocol for excluding B12 deficiency (Megaloblastic anemia/ Pernicious Anaemia) from adult and child patient presentation Relevance This protocol is relevant to all diagnosing clinicians, ie GPs and Nurses.
More informationICD-10 CM/PCS Tip Sheets. Oncology
ICD-10 CM/PCS Tip Sheets Oncology About This Guide This collection of tip sheets has been developed by Cape Fear Valley Health to promote greater specificity of the coded data for a given condition, disease,
More informationMemantine (Ebixa) Drug treatment for Alzheimer s disease
IS 20 October 2011 Information sheet Memantine (Ebixa) Drug treatment for Alzheimer s disease Introduction... 1 How does Ebixa work?... 1 Who might benefit?... 2 What effect might Ebixa have?... 2 How
More informationBackground. 5. Where provider organisations are reviewing the provision of GF staple foods on
Policy Statement Gluten Free Food on Prescription Statement Summary Coeliac disease is a lifelong autoimmune condition caused by an abnormal immune response to eating gluten. It is one of the most common
More informationThe Scottish Public Services Ombudsman Act 2002
Scottish Public Services Ombudsman The Scottish Public Services Ombudsman Act 2002 Investigation Report UNDER SECTION 15(1)(a) SPSO 4 Melville Street Edinburgh EH3 7NS Tel 0800 377 7330 SPSO Information
More informationNutritional Challenges After Surgery
Nutritional Challenges After Surgery L I N D A P A T A K I M S R D C S O L D C N S C M D A N D E R S O N C A N C E R C E N T E R H O U S T O N, T E X A S Objectives Identify the reasons that GIST and its
More informationPOAC CLINICAL GUIDELINE
POAC CLINICAL GUIDELINE Acute Pylonephritis DIAGNOSIS COMPLICATED PYELONEPHRITIS EXCLUSION CRITERIA: Male Known or suspected renal impairment (egfr < 60) Abnormality of renal tract Known or suspected renal
More informationICD-9-CM/ICD-10-CM Codes for MNT
/ Codes for MNT ICD (International Classification of Diseases) codes are used by physicians and medical coders to assign medical diagnoses to individual patients. It is not within the scope of practice
More informationTHYROID AND COELIAC DISEASE IN TYPE 1 DIABETES
THYROID AND COELIAC DISEASE IN TYPE 1 DIABETES Information Leaflet Your Health. Our Priority. Page 2 of 5 Information for parents Thyroid disease, Type 1 Diabetes and Coeliac disease are all `autoimmune`
More informationWhat can happen if you have low iron levels?
Iron in your diet Iron in your diet Why is iron important? Iron is important because it helps your body to make haemoglobin. Haemoglobin, or Hb, is the protein found in red blood cells that carries oxygen
More informationALS and Lyme Disease Questions from Patient and Families Responses from Medical Experts
ALS and Lyme Disease Questions from Patient and Families Responses from Medical Experts Introduction: When anyone receives a diagnosis of ALS, it is normal and understandable to ask why you ve developed
More informationA Guide to Monitoring Blood Glucose for Patients with diabetes in Care Homes
A Guide to Monitoring Blood Glucose for Patients with diabetes in Care Homes 1. Summary... 1 2. Background... 2 3. Purpose 2 4. Responsibilities. 2 5. Blood Glucose Monitoring. 2 6. Resident Groups that
More informationSouthern Derbyshire Shared Care Pathology Guidelines. Hyperkalaemia
Southern Derbyshire Shared Care Pathology Guidelines Hyperkalaemia Purpose of Guideline Dealing with adult patients with Hyperkalaemia in the community Definition Serum potassium normal range is 3.5 5.3
More informationEnoxaparin for long term anticoagulation in patients unsuitable for oral anticoagulants
Enoxaparin for long term anticoagulation in patients unsuitable for oral anticoagulants Traffic light classification- Amber 2 Information sheet for Primary Care Prescribers Relevant Licensed Indications
More informationGUIDELINES FOR THE USE OF PALIPERIDONE PALMITATE (Xeplion ) Version: 2
SH CP 29 GUIDELINES FOR THE USE OF PALIPERIDONE PALMITATE (Xeplion ) Summary: Guidelines for the use of paliperidone palmitate (Xeplion ) Keywords (minimum of 5): (To assist policy search engine) Target
More informationObjectives. What is undernutrition? What is undernutrition? What does undernutrition look like?
Objectives Basics Jean-Pierre Habicht, MD, PhD Professor Division of Nutritional Sciences Cornell University Types and causes Determinants Consequences Global occurrence and progress Way forward What is
More informationSouthern Derbyshire Shared Care Pathology Guidelines. Vitamin D
Southern Derbyshire Shared Care Pathology Guidelines Vitamin D Purpose of guideline Provide clear advice on when to measure vitamin D and identify patients with insufficiency and deficiency. To provide
More informationEffective Treatment of Lyme Borreliosis with Pentacyclic Alkaloid Uncaria tomentosa (TOA-free Cat s Claw)
Effective Treatment of Lyme Borreliosis with Pentacyclic Alkaloid Uncaria tomentosa (TOA-free Cat s Claw) Executive Summary Introduction In a six-month prospective cohort study designed to compare the
More informationNHS FORTH VALLEY Adult Adrenal Insufficiency Management Guidelines
NHS FORTH VALLEY Adult Adrenal Insufficiency Management Guidelines Date of First Issue 01 August 2006 Approved 01 August 2006 Current Issue Date 30 th May 2014 Review Date 1 st July 2018 Version 1.2 EQIA
More informationTuberculosis And Diabetes. Dr. hanan abuelrus Prof.of internal medicine Assiut University
Tuberculosis And Diabetes Dr. hanan abuelrus Prof.of internal medicine Assiut University TUBERCULOSIS FACTS More than 9 million people fall sick with tuberculosis (TB) every year. Over 1.5 million die
More informationFrequently Asked Questions
Frequently Asked Questions Business Office: 598 Airport Boulevard Suite 1400 Morrisville NC 27560 Contact: support@cognitrax.com Phone: 888.750.6941 Fax: 888.650.6795 www.cognitrax.com Diseases of the
More informationShort Synacthen Test for the Investigation of Adrenal Insufficiency
Pathology at the Royal Derby Hospital Short Synacthen Test Standard Clinical Guidelines Chemical Pathology Department Valid Until 31 st March 2015 Document Code: CHISCG1 Short Synacthen Test for the Investigation
More informationBlood Testing Protocols. Disclaimer
Blood Testing Protocols / Page 2 Blood Testing Protocols Here are the specific test protocols recommend by Dr. J.E. Williams. You may request these from your doctor or visit www.readyourbloodtest.com to
More informationReview Group: Mental Health Operational Medicines Management Group. Signature Signature Signature. Review Date: December 2014
Mental Health NHS Grampian Mental Health Service Staff Guidance For The Prescribing Of Vitamin Supplementation During In-Patient Admission (Mental Health) For Alcohol Withdrawal Co-ordinators: Consultant
More informationFastTest. You ve read the book... ... now test yourself
FastTest You ve read the book...... now test yourself To ensure you have learned the key points that will improve your patient care, read the authors questions below. The answers will refer you back to
More informationMANAGING ANEMIA. When You Have Kidney Disease or Kidney Failure. www.kidney.org
MANAGING ANEMIA When You Have Kidney Disease or Kidney Failure www.kidney.org About the Information in this Booklet Did you know that the National Kidney Foundation (NKF) offers guidelines and commentaries
More informationCrohn s and Colitis Center
Crohn s and Colitis Center Dedicated to caring for patients with inflammatory bowel disease Crohn s disease and ulcerative colitis. The Crohn s and Colitis Center is the only center in New England exclusively
More informationVersion 2 This guideline describes how to manage patients who are showing signs and symptoms of alcohol withdrawal and Wernicke s Encephalopathy.
Title of Guideline (must include the word Guideline (not protocol, policy, procedure etc) Contact Name and Job Title (author) Directorate & Speciality A Guideline for the Management of Acute Alcohol Withdrawal
More informationVitamin B12 1200 mcg Timed Release Tablets
Vitamin B12 1200 mcg Timed Release Tablets Product Summary: Vitamin B12 (cyanocobalamin) is a water soluble vitamin necessary for energy production; for nervous system function as it is needed to produce
More informationThe Nuts and Bolts of Multiple Sclerosis. Rebecca Milholland, M.D., Ph.D. Center for Neurosciences
The Nuts and Bolts of Multiple Sclerosis Rebecca Milholland, M.D., Ph.D. Center for Neurosciences Objectives Discuss which patients are at risk for Multiple Sclerosis Discuss the diagnostic criteria for
More information1333 Plaza Blvd, Suite E, Central Point, OR 97502 * www.mountainviewvet.net
1333 Plaza Blvd, Suite E, Central Point, OR 97502 * www.mountainviewvet.net Diabetes Mellitus (in cats) Diabetes, sugar Affected Animals: Most diabetic cats are older than 10 years of age when they are
More informationGUIDELINE FOR NURSES RE-ISSUING ORAL CONTRACEPTIVE PILLS
GUIDELINE FOR NURSES RE-ISSUING ORAL CONTRACEPTIVE PILLS The purpose of this guideline is to identify those women who can safely be reissued pills by practice nurses without needing to see a doctor. It
More informationThe Oxford IBD Service
Gastroenterology Unit, John Radcliffe Hospital The Oxford IBD Service Information for patients Information for patients 1 The Oxford Inflammatory Bowel Disease (IBD) Service Consultant Gastroenterologists
More informationNHS FORTH VALLEY RIVAROXABAN AS TREATMENT FOR DEEP VEIN THROMBOSIS AND PULMONARY EMBOLISM IN ADULTS
NHS FORTH VALLEY RIVAROXABAN AS TREATMENT FOR DEEP VEIN THROMBOSIS AND PULMONARY EMBOLISM IN ADULTS Date of First Issue 01/12/ 2012 Approved 15/11/2012 Current Issue Date 29/10/2014 Review Date 29/10/2016
More informationVitamin D. Why Vitamin D is important and how to get enough
Vitamin D Why Vitamin D is important and how to get enough Why is vitamin D vital for health? Vitamin D is needed by the body for both physical and mental health, but is best known for making sure bones
More informationVictorian Nurse Practitioner Project Phase 4, Round 4.11 - Chronic Disease Management
Victorian Nurse Practitioner Project Phase 4, Round 4.11 - Chronic Disease Management Eastern Health Multiple Sclerosis Nurse Practitioner Service Model April 2014 Prepared by Jodi Haartsen and Deanna
More informationObstetrics and Maternity
Patient Blood Management Guidelines: Module 5 Obstetrics and Maternity Quick Reference Guide National Blood Authority, 2015. With the exception of any logos and registered trademarks, and where otherwise
More informationConclusions of a WHO Technical Consultation on folate and vitamin B 12 deficiencies
Conclusions of a WHO Technical Consultation on folate and vitamin deficiencies Key words: Folate, vitamin Preamble Folate and vitamin deficiencies occur primarily as a result of insufficient dietary intake
More informationDietitian, Nutritionist, Nutritional Therapist or Diet Expert? A comprehensive guide to roles and functions.
Dietitian, Nutritionist, Nutritional Therapist or Diet Expert? A comprehensive guide to roles and functions. 1 Dietitians Choosing the right person to seek help and advice from can sometimes be a confusing
More informationHow To Treat An Elderly Patient
1. Introduction/ Getting to know our Seniors a. Identify common concepts and key terms used when discussing geriatrics b. Distinguish between different venues of senior residence c. Advocate the necessity
More informationTest Request Tip Sheet
With/Without Contrast CT, MRI Studies should NOT be ordered simultaneously as dual studies (i.e., with and without contrast). Radiation exposure is doubled and both views are rarely necessary. The study
More informationMicronutrient. Functio. Vitamin A
EHPM Leaflet UK 25/4/00 14:50 Page 1 (1,1) Vitamin and mineral intake We cannot, however, afford to be complacent about our intake of vitamins and minerals. Poor diets with low quantities of fruit and
More informationPreventive Services Explained
Preventive Services Explained Medicare covers many preventive care services without charge. Most of these services have been recommended by the U.S. Preventive Services Task Force. However, which beneficiaries
More informationIron deficiency Anaemia
Iron deficiency Anaemia We need iron for many important body functions, the most important of which is the manufacture of haemoglobin, the oxygen-carrying protein in our blood. Iron is absorbed from food
More informationAcute pelvic inflammatory disease: tests and treatment
Acute pelvic inflammatory disease: tests and treatment Information for you Information for you Published August 2010 Published in August 2010 (next review date: 2014) Acute What is pelvic inflammatory
More informationCrohn's disease and ulcerative colitis
Crohn's disease and ulcerative colitis Summary Crohn s disease and ulcerative colitis are collectively known as inflammatory bowel disease (IBD). Crohn s disease can appear in any part of a person s digestive
More informationMedical Records Analysis
Medical Records Analysis Karen A. Mulroy, Partner Evans & Dixon, L.L.C. The analysis of medical legal issues posed in any case can be complicated, requiring some close reading and detective work to both
More informationNHS FORTH VALLEY Thyroid Storm
NHS FORTH VALLEY Thyroid Storm Date of First Issue 01 August 2006 Approved 01 August 2006 Current Issue Date 1 st July 2016 Review Date 1 st July 2018 Version EQIA Yes 01/08/2010 Author / Contact Group
More informationBOMSS Guidelines on peri-operative and postoperative biochemical monitoring and micronutrient replacement for patients undergoing bariatric surgery
BOMSS Guidelines on peri-operative and postoperative biochemical monitoring and micronutrient replacement for patients undergoing bariatric surgery Authors Ms Mary O Kane, Consultant Dietitian, Leeds Teaching
More informationWhy iron and haemoglobin are important
Iron and haemoglobin Why iron and haemoglobin are important Meet Kylie Kylie is a blood donor. Kylie knows that having a healthy iron enriched diet will help restore the iron removed with blood donation.
More information