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Electronic Prescription

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4181. Opioid Analgesics

(DH) reduced the maximum permissible duration of Schedule 2, 3 and 4 drug prescriptions to 30 days in June 2006. The DH has withdrawn the requirement that all prescriptions for controlled drugs should be handwritten since 2007. More recently, amendments to regulations allow the signature on a prescription for a controlled drug to be electronic if the Electronic Prescribing Service (EPS) is used. A recent update to the DH guidance on supervision and management of the use of controlled drugs (...) and codeine and dihydrocodeine come under Schedule 5. Prescriptions for need to include: The patient's full name, address and age, where appropriate. Name and form of the drug, even if only one form exists. The strength of a preparation, where appropriate. The dose to be taken. The total quantity to be supplied, in words and figures. The prescriber's signature and the date of the prescription. No repeat ordering: prescriptions ordering repeats on the same form are not permitted. The Department of Health

2008 Mentor

4182. Pyrexia of Unknown Origin (PUO)

. Discuss nutrition, including consumption of dairy products and the source of these products. Drug history should be recorded, to include over-the-counter medications, prescription medications and any illicit substances. Immunisation status should be documented. Enquire about family history of illness. Occupational history should include exposure to chemicals/animals. Take a history of travel and recreational habits - including possible exposure to ticks and other vectors. Sexual history should (...) be recorded. Examination of the patient should include: Documentation of fever and exclusion of factitious fever (may be up to 10% of cases), which are essential early steps in the physical examination. Measuring the fever more than once and in the presence of another. Electronic thermometers give access to rapid and unequivocal documentation of fever. Diseases such as brucellosis, borreliosis and Hodgkin's disease tend to cause recurrent episodes of fever. Physical examination should be repeated daily

2008 Mentor

4183. Obesity in Adults

weight after stopping treatment but trials suggest it takes three years to gain weight lost in one year on the drug. Indications - individuals with a BMI of 28 kg/m 2 or more in the presence of significant comorbidities (eg, type 2 diabetes, high blood pressure, hyperlipidaemia) OR a BMI of 30 kg/m 2 or more with no associated comorbidities. [ ] These individuals should be on a mildly hypocaloric, low-fat diet. Prescription : Availability: this is now available over-the-counter (OTC) to individuals (...) .2010.03.008. ; NICE Evidence Services (UK access only) ; Roche Products Limited, electronic Medicines Compendium, June 2014 ; Obesity management: update on orlistat. Vasc Health Risk Manag. 20073(6):817-21. ; Orlistat-associated adverse effects and drug interactions: a critical review. Drug Saf. 200831(1):53-65. ; Current and future drug targets in weight management. Pharm Res. 2011 Aug28(8):1792-818. doi: 10.1007/s11095-010-0341-1. Epub 2010 Dec 23. ; Medicines and Healthcare products Regulatory Agency

2008 Mentor

4184. History and Physical Examination

patient may be taking co-codamol. The computer will record if medication is overused or underused and the date of last issue. Enquire about over-the-counter (OTC) remedies and possible herbal or other treatments. The latter are just as likely as prescription-only medicines (POMs) to have toxic effects or drug interactions, perhaps more so as they have not been so thoroughly tested. Family history Patients also assume that their family doctor is aware of their family history. Many conditions do have (...) apparent. The doctor should have a protocol for each system. Many forms of examination have their own article covering appropriate topics listed below. All general practitioners should have competence in: , including . . . Checking for and . . . Competence at orthopaedic examination, which should include , , , and assessment of . Examination of tender, . . . . . . . Management In the 1980s, handing over a prescription indicated the end of the consultation. It is now recognised that educating

2008 Mentor

4185. General Prescribing Guidance

and formulation. Adverse effects. Checking dosages. Using prescribing formularies. Keeping up to date and following clinical guidelines, where available, from the National Institute for Health and Care Excellence (NICE) or Scottish Intercollegiate Guidelines Network (SIGN). Using electronic systems where available that can enhance the safety of prescribing. Responsible delegation of prescribing administration and dispensing. Prescribing guidance Writing prescriptions [ ] Many prescriptions are now computer (...) at regular intervals over the agreed period of time. Electronic prescriptions [ ] Increasingly, electronic prescribing is being rolled out in England, where prescribers can send prescriptions electronically to a chemist of the patient's choice. This potentially improves safety, efficiency and convenience. Prescribing organisations must be authorised to use the service by NHS England. Shared care prescriptions [ ] There can potentially be some confusion around ongoing prescriptions of a drug

2008 Mentor

4186. Ezetimibe

: If you are pregnant, trying for a baby, or breast-feeding. If you have any problems with the way your liver works. If you are taking any other medicines. This includes any medicines you are taking which are available to buy without a prescription, as well as herbal and complementary medicines. If you have ever had an allergic reaction to a medicine. How to take ezetimibe Before you start the treatment, read the manufacturer's printed information leaflet from inside the pack. It will give you more (...) health and lifestyle content. By clicking 'Subscribe' you agree to our and . Subscribe Thanks for your feedback. if you would like to report a specific issue with this page, please visit our . Thank you, we just sent a survey email to confirm your preferences. Further reading and references ; Merck Sharp & Dohme Limited, The electronic Medicines Compendium. Dated February 2016. British National Formulary; 72nd Edition (Sep 2016) British Medical Association and Royal Pharmaceutical Society of Great

2008 Mentor

4187. Email Consultations in Healthcare

between staff members - eg, messages concerning patient care. External email between patients and clinicians - eg, questions regarding treatment, seeking repeat prescriptions. External email between clinicians - eg, seeking advice/updates regarding shared care patients. External email between clinicians and other health workers - eg, public health 'cascade' systems for disseminating information quickly. External email between practice, clinical commissioning group (CCG) and other health authority (...) administrators. Whilst our lives increasingly revolve around the checking of electronic inboxes, the most controversial of these uses is for clinical consultation. Despite policy pressure to introduce consultations by email and internet video, there has been a general reluctance among GPs to implement alternatives to face-to-face consultations. [ ] Email's asynchronicity (parties do not have to be simultaneously present, unlike telephone conversations) and the speed of its transmission are particularly

2008 Mentor

4188. Antimicrobial Eye Preparations

to work (five to seven days in bacterial conjunctivitis) before considering any change in antimicrobial preparation, or referral. Have a low referral threshold in the presence of pain (as opposed to discomfort, itching, tearing, etc). Avoid prescription of preparations combining antibiotics with corticosteroids: patients requiring steroids should be assessed and monitored in a specialist unit. Advise the patient to withhold from wearing contact lenses during the period of infection. See separate (...) Dec59(569):897-900. doi: 10.3399/bjgp09X473132. ; Bausch & Lomb UK Limited, electronic Medicines Compendium, May 2016 ; Allergan Ltd, electronic Medicines Compendium, April 2016 ; Amdipharm Mercury Company Limited, electronic Medicines Compendium, February 2015 The Wills Eye Manual Oxford Handbook of Ophthalmology hi everyone i am maria. So i'm really worried about my ma because of her eyes. Back in the day before i was born she got laser eye surgery. Fast forward to now, yesterday my mom went

2008 Mentor

4189. Antiplatelet Drugs

for primary and secondary prevention of CVD, although a lot of cardiologists seem to use 150 mg daily. GI side-effects are common with aspirin: Advise patients to report any abdominal pain, melaena or rectal bleeding urgently. There is no evidence that enteric coating or dispersible formulations of aspirin lessen the risk. Ensure that it is taken with food. Co-prescription of symptomatic or preventative medication - for example, maintenance dose protein pump inhibitor (PPI) - should be used prior (...) a survey email to confirm your preferences. Further reading and references ; BBC News Report November 2010 ; Antiplatelet treatment in stable coronary artery disease. Heart. 2003 Oct ; SANOFI, electronic Medicines Compendium, Jan 2014 ; A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). CAPRIE Steering Committee. Lancet. 1996 Nov 16 ; NICE Technology Appraisal Guidance, December 2010 ; NICE Technology Appraisal Guidance, July 2014 ; Boehringer

2008 Mentor

4190. Amiodarone

of potassium in your blood. If you have a rare inherited blood disorder called porphyria. If you are pregnant or breastfeeding. If you are taking any other medicines. This includes any medicines you are taking which are available to buy without a prescription, as well as herbal and complementary medicines. If you have ever had an allergic reaction to a medicine. It is particularly important that you tell your doctor if you know you are allergic to iodine. How to take amiodarone Before you start (...) to send you our articles and latest news by email, giving you the best opportunity to stay up to date with expert written health and lifestyle content. By clicking 'Subscribe' you agree to our and . Subscribe Thanks for your feedback. if you would like to report a specific issue with this page, please visit our . Thank you, we just sent a survey email to confirm your preferences. Further reading and references ; Zentiva, The electronic medicines Compendium. Dated September 2016. British National

2008 Mentor

4191. Abbreviations

of confinement EDD expected date of delivery EDS excessive daytime sleepiness EER experimental event rate EFWC electrolyte-free water clearance eGFR estimated glomerular filtration rate EIA enzyme immunoassay ELISA enzyme-linked immunosorbent assay EMA endomysial antibodies EMDA electromotive drug administration EMDAS encephalomyoduroarteriosynangiosis EMG electromyography ENG electronystagmography eod every other day EOG electro-oculogram ePACT electronic Prescribing Analysis and Cost Tool EPDS Edinburgh (...) Postnatal Depression Scale ePFIP electronic Prescribing and Financial Information for Practices EPO erythropoietin EPSEs extra-pyramidal side-effects ER (o)estrogen receptor ERCP endoscopic retrograde cholangiopancreatography ERG electroretinography ERP exposure and relapse prevention ERT enzyme replacement therapy ESBL extended-spectrum beta-lactamase ESES electrical status epilepticus in sleep ESR erythrocyte sedimentation rate ESWL extracorporeal shock wave lithotripsy EUA examination under

2008 Mentor

4192. Drug Eruptions

-epileptics and others). [ ] Notification of adverse drug reaction is on a voluntary basis through the Yellow Card Scheme in the British National Formulary. An electronic version is also available online at . Diagnosis History and examination are as important here as in any field. [ ] When a patient develops a dermatological problem it is often difficult to decide which, if any, drugs are responsible. [ ] Take a careful history, avoiding being too ready to accept the patient's diagnosis of what (...) is to blame, especially if they are on multiple medication. Take note of all medication, including prescribed, over-the-counter (OTC), 'alternative' and illicit drugs. It is not only prescription-only medications (POMs) that can cause trouble and patients may be surprised to learn that OTC products, 'natural therapies' and illegal drugs can also have adverse effects. Urticaria may not be due to a drug at all but the ingestion of strawberries or shellfish. There may be a viral infection. Has the patient

2008 Mentor

4193. Doctor's Bag - Contents

and all GPs may be required to identify themselves to other emergency services. Mobile phone - smartphones may also serve a number of other functions but this may be dependent on adequate reception. Stationery and a limited number of FP10 prescriptions, Med3 (fit notes), letter-headed paper and envelopes. British National Formulary or equivalent - but electronic versions of these which can be used via a smartphone or tablet are available and can replace the need for printed reference material (...) . Investigation forms. Local map or electronic equivalent - satnav/GPS or smartphone. Personal alarm - several versions are readily available. The police suggest that when used, an alarm be thrown about 10-20 feet to cause distraction. Diagnostic equipment Stethoscope and pocket diagnostic set. Sphygmomanometer and infrared thermometer - sphygmomanometers should have calibration date stickers. Pulse oximeter. Glucometer including appropriate strips and lancets. Alcohol wipes, gloves, lubricating jelly

2008 Mentor

4194. Data Security and Caldicott Guardianship

, Caldicott Guardians were appointed to safeguard information sharing. However, keeping NHS patient data secure has become ever more complex with evolution of electronic records and with the recent advent of contractual data sharing. In England, the Summary Care Record and Care.data programmes, along with the Patient Online programme, have made the understanding of data security issues increasingly important and increasingly complex for GPs. Despite the now mandatory nature of these data sharing (...) implications of having online access to book appointments, request repeat prescriptions or view their record. This includes the patient's responsibility to maintain the safety and security of the information in their record. (There are a number of patient information leaflets available on both NHS England and the Royal College of General Practitioners (RCGP) websites.) This involves an enormous amount of administrative work; checking records individually, verifying ID, setting up practice protocols, etc

2008 Mentor

4195. Alport's Syndrome

is commonly, but not universally, observed in patients with AS. Hearing loss is never present at birth but usually becomes apparent by late childhood or early adolescence, generally before the onset of chronic kidney disease. Ocular abnormalities: lens - cataracts, microspherophakia, posterior or anterior lenticonus. Anterior lenticonus is the pathognomonic feature of AS. It is a slow, progressive deterioration of vision. Patients need to change the prescription of their glasses frequently (...) (RBCs) and RBC casts. Renal biopsy: light microscopy shows mesangial cell proliferation and capillary wall thickening, progressing to glomerular sclerosis and tubulo-interstitial changes. Electron microscopy: this shows GBM changes including splitting of lamina densa and lamellation. Gingival biopsy: changes in gingival tissues have been reported as a consequence of AS and may prove to be be an alternative initial diagnostic tool. [ ] Management There is no definitive treatment for AS. Control

2008 Mentor

4196. Amblyopia

is compliance. [ ] This may also be the greatest challenge. [ ] It is worth noting that, although it is unpleasant for both child and parent, standard psychological assessments have detected no significant psychological distress. However, prescriptions should take the difficulty of following treatment into account and minimise the amount of hours of patching prescribed. Parents need good information and education, as do children when they are old enough to understand. [ ] Whilst both patching (...) analysis of 322 Br J Ophthalmol. 2010 Aug94(8):1007-11. Epub 2009 Dec 2. ; Conventional occlusion versus pharmacologic penalization for amblyopia. Cochrane Database Syst Rev. 2009 Oct 7(4):CD006460. ; Video-game play induces plasticity in the visual system of adults with amblyopia. PLoS Biol. 2011 Aug9(8):e1001135. Epub 2011 Aug 30. ; Reverse amblyopia with atropine treatment. Binocul Vis Strabismus Q. 200924(1):25-31. ; Psychological causes of non-compliance with electronically monitored occlusion Br

2008 Mentor

4197. Cannabis Use and Abuse

Dec 13. ; Sativex long-term use: an open-label trial in patients with spasticity due to multiple sclerosis. J Neurol. 2013 Jan260(1):285-95. doi: 10.1007/s00415-012-6634-z. Epub 2012 Aug 10. ; Medicines and Healthcare products Regulatory Agency (MHRA), December 2007 (archived content) ; Medicines and Healthcare products Regulatory Agency (MHRA) ; GW Pharma Ltd, electronic Medicines Compendium, March 2015 ; Managing neuropathic pain with Sativex: a review of its pros and cons. Expert Opin (...) Pharmacother. 2008 May9(7):1189-95. doi: 10.1517/14656566.9.7.1189. ; Efficacy of two cannabis based medicinal extracts for relief of central neuropathic pain from brachial plexus avulsion: results of a randomised controlled trial. Pain. 2004 Dec112(3):299-306. ; Randomized controlled trial of Sativex to treat detrusor overactivity in multiple sclerosis. Mult Scler. 2010 Nov16(11):1349-59. doi: 10.1177/1352458510378020. Epub 2010 Sep 9. ; Conditional okay for cannabis prescription drug. CMAJ. 2005 Jun

2008 Mentor

4198. Telephone Consultations (PubMed)

appointments without loss of clinical value or patient satisfaction. [ , ] Can be used to provide a triage system for same-day appointment requests ensuring patients who need to be seen can be given appointments at times when demand is high. [ ] Can reduce workload - about 50% telephone consults result in telephone advice alone. However there is some evidence that nurse triage increases complexity and workload at the next GP consultation eg more presenting problems, more prescriptions and investigations (...) patient record (paper or electronic). Sometimes it will be useful to record verbatim what is said by you and the patient. On occasion, it may be important to reinforce important information with a letter - eg"Further to our telephone consultation today I would like to emphasise the importance of avoiding aspirin whilst on warfarin - and I enclose a patient information leaflet". Many of our day to day telephone calls to commercial organisations are recorded - often "for training purposes

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2008 Mentor Controlled trial quality: predicted high

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