Health A – Z  2016 2018

Having fluids administered directly into a vein while under the influence of alcohol will not make you feel better any more quickly.

See the NHS website for further information on the effects of drinking. alcohol.

When you have a respiratory tract infection the side effects of antibiotics may outweigh the benefits. This should be discussed with your doctor.

More information\ decision support material

Adults and children:

NHS Choices. Antibiotics.

Public Health England. Treating your infection leaflets.

NHS Choices. Vaccinations.

 

Children:

 Caring for children with coughs

When should I worry?

The side effects of antibiotics at end of life may outweigh the benefits.

More information\ decision support material

NHS Choices. Antibiotics.

Public Health England. Treating your infection leaflets.

Antibiotics can occasionally be used for conditions that are not infections. The risks and side effects may outweigh any benefits. Choose carefully with your doctor whether these will be beneficial to you.

More information\ decision support material

NHS Choices. Antibiotics.

Public Health England. Treating your infection leaflets.

Not all pregnant women should have antibiotics for group B Streptococcus before labour starts

If you have had a swab taken in pregnancy which detects group B Streptococcus (also known as GBS or Strep B), you do not need treatment for this during your pregnancy before labour starts. You should be offered antibiotics through a drip as soon as possible once labour starts to reduce the small risk of this infection being transferred to your baby. If you have urine infection caused by group B Strep, you should be treated with antibiotic tablets straight away and also be offered antibiotics through a drip during labour. You should be given information on what group B Strep in pregnancy means for you and your baby and your healthcare professional will discuss your individual circumstance and preferences with you with.

More information\ decision support material

The Royal College of Obstetricians and Gynaecologists provides detailed information on Group B Streptococcal infection in pregnancy:

Additional information from charity Group B Strep Support www.gbss.org.uk

Even if you have bacteria detected in a urine test, it does not necessarily mean you need antibiotics.

NHS Choices. Antibiotics.

Public Health England. Treating your infection leaflets.

When discussing treatment for adult schizophrenia with your doctor or specialist nurse, you or your advocate should consider whether medications taken by mouth or longer-acting medications given by injection would be better for you.

See the NHS website for further information on treating and living with schizophrenia.

Back pain is common and effects most people at some point in their lives. If you have back pain and there are no other concerning features (such as compression of the nerve roots) you are unlikely to need investigations such as X-rays.

The NHS website has detailed information on back pain and what you can do to help yourself to prevent and care for back pain.

Before having a blood transfusion, you should always discuss the risks and benefits with your doctor, unless it’s an emergency

More information\ decision support material

A number of patient information materials are available through the NHSBT website:

Will I need blood transfusion?

You should only receive a blood transfusion if it is really necessary, such as for major bleeding or severe anaemia, and not if alternatives are available such as iron treatment if you have iron deficiency anaemia. As an adult, you should only receive one unit of blood at a time unless you are bleeding heavily.
You should be provided with information about the benefits and risks of blood transfusion and have the opportunity to ask questions.

More information on blood transfusions can be found on the NHS choices website. 

You should only receive a blood transfusion if it is really necessary, such as for major bleeding or severe anaemia, and not if alternatives are available such as iron treatment if you have iron deficiency anaemia. As an adult, you should only receive one unit of blood at a time unless you are bleeding heavily.
You should be provided with information about the benefits and risks of blood transfusion and have the opportunity to ask questions.

More information on blood transfusions can be found on the NHS choices website. 

Small fractures of the base of the fifth metatarsal, a bone on the outside of the foot, do not usually need to be put into a plaster cast as they will heal just as quickly in a removable boot.

More information on caring for broken bones can be found on the NHS choices website.

Calcium testing is used when there are symptoms of kidney stones, bone disease or nerve-related disorders. It is not necessary to have a test if you have had one within the last three months unless you undergo major surgery or become seriously unwell.

More information on calcium and how to get the right amount can be found on the NHS choices website.

There is no one way to come to terms with a life-threatening illness. Decisions about your care must always suit your own personal beliefs and circumstances.

Terminal cancer will often involve difficult decisions about your quality of life versus longevity. The decision as to what treatment is best for you will always be yours, and it is important that you discuss it fully with your loved ones, doctors and specialist nurses.

Patients with cancer that cannot be cured are frequently treated with palliative chemotherapy. This is sometimes used to shrink the cancer or to eliminate distressing symptoms. A patient’s individual response to these powerful drugs depends on the nature of their tumour. As more and more different types of chemotherapy are used, a meaningful response becomes less and less likely. Furthermore, if one type of chemotherapy has failed altogether, then it is unlikely a different type of chemotherapy will work either.

Chemotherapy is by its very nature toxic. Therefore the combination of failing to achieve a response and causing toxicity can ‘do more harm than good’. Finally, the use of chemotherapy with a low chance of a meaningful response can raise false hopes.
If you have advanced cancer, the use of chemotherapy where the benefit is likely to be small and the harm may be great should be carefully considered.

Similarly, if you are receiving palliative chemotherapy or radiotherapy, post-treatment CT scans or Magnetic Resonance Imaging (MRI) are unlikely to be of benefit to you or influence the decisions of the team looking after you. What really matters is how you feel and whether your symptoms improve after the treatment.
The NHS Choices website has more information on cancer and end of life care.

Not all cases of cataracts require surgery. Every person is different so before referral, discuss the following with your doctor:

  • How the cataract affects your vision and quality of life
  • Whether 1 or both eyes are affected
  • What cataract surgery involves, including possible risks and benefits
  • How your quality of life may be affected if they choose not to have cataract surgery
  • Whether you want to have cataract surgery

More information\ decision support material

Patient information on Cataract surgery can be found at NHS Choices, Patient.info and there is an NHS Right Care shared decision aid

There are risks to having cataracts surgery and you should discuss these with your doctors before you are referred

More information\ decision support material

Patient information on Cataract surgery can be found at NHS Choices, Patient.info and there is an NHS Right Care shared decision aid

If you have an uncomplicated cataract operation, then you do not need to be reviewed by your doctor the day after your operation.
For more information on cataracts see the NHS choices website

The NHS Shared decision making aid on cataracts may help you choose the right decision for you and help with conversations with your doctor and optician.

Doctors and patients should discuss the risks and benefits of having cataracts surgery on both eyes on the same day.

Patient information on Cataract surgery can be found at NHS Choices, Patient.info and there is an NHS Right Care shared decision aid

Women can have routine cervical smears taken if they are due at the time that they are attending for other sexual health issues.

More information\ decision support material

NHS Choices. Cervical Screening

Small fractures on one side of the wrist, commonly known as ‘buckle fractures’, do not normally need a plaster cast. They can usually be treated and get better just as quickly with a removable splint accompanied with written information for care. There is also usually no need for follow up in a fracture clinic.
More information on caring for broken and fractured bones can be found on the NHS choices website.

In most cases, bronchiolitis, which is an inflammation of the small breathing tubes in the lung, gets better without treatment. Although seeing your child with breathing difficulties can be distressing, acute bronchiolitis should not be treated with medications called bronchodilators, which cause a widening of the small breathing tubes in the lung, as they have been shown to have little or no effect.

NHS choices gives more information on identifying and treating bronchiolitis at home and when to take to your child to the doctor.

Polyethylene Glycol should be used in preference to Lactulose in the treatment of chronic constipation in children.

For more information on constipation the following websites provide explanations and ways to help relieve the symptoms.

The NHS choices website on constipation.
Patient website on constipation in children.

If your child is having a prolonged seizure, giving medications (such as Midazolam and Lorazepam) which can be dissolved in the mouth are preferred to medications which are injected or administered by means of a suppository. This is because there is good evidence too, that medications which can be dissolved in the mouth are just as effective, easier to administer and patients and families usually prefer them. This route may also stop seizures sooner, resulting in fewer admissions to hospital and less admissions to intensive care.

For more information on epilepsy see the epilepsy society website.
The Medicines for Children website has more information on oral treatments for stopping seizures.

Helmet therapy is not effective in the treatment of plagiocephaly, which is also known as flat head syndrome, other treatment options should be considered and discussed with your doctor or specialist nurse, such as adjusting your child’s sleep patterns, ‘tummy time’ and physiotherapy.

More information on plagiocephaly symptoms and treatments can be found on the NHS Choices website and the Great Ormond Street Hospital for Children website.

If a child under 12 months old has a recurrent sticky eye and a suspected blocked tear duct, surgery to unblock it is not required until they are over 12 months as it commonly resolves prior to this.

If conjunctivitis is thought to be viral there is no need to send samples to the laboratory or to treat with antibiotics.
For more information on conjunctivitis see the NHS choices website

If you have a coil (intrauterine device, IUD) fitted to prevent pregnancy, you should be taught to check its placement by feeling the threads inside the vagina. This should be done regularly in the first month after it has been fitted and then after each of your periods or at regular intervals. You only need to seek professional advice when you cannot feel the threads.

NHS choices website provides more information on the coil and how to check it is still in place.

Women requesting intrauterine contraception can attend for a one-stop consultation and insertion appointment provided they have access to high quality local guidance on the procedure and its risks and benefits e.g. online website resources including a check-list.

Studies have shown that drinking quality tap water is just as effective for cleaning and washing cuts and grazes as sterile saline solution.

The NHS choices website provides more information on caring for cuts and grazes.

Cochrane Review: The effects of water compared with other solutions for wound cleansing.

Cognitive testing alone does not diagnose dementia.

In order to establish an accurate diagnosis of dementia your doctors are recommended to obtain a full history, including information from key family members and conduct cognitive assessment.

More information\ decision support material

NICE Guidance

Your doctor should use non-drug treatments for the management of behavioural and psychological symptoms of dementia.

If there are significant risks that make treatment with an antipsychotic necessary, this should be discussed with in details with you and your family, and the lowest possible dose used.

More information\ decision support material

Treatments for different types of dementia

Drugs to relieve behavioural psychological symptoms

Pain as a common cause of agitation in patients with dementia.

50% of people with dementia are estimated to experience regular pain. Despite this, current assessment and treatment of pain in this patient group are inadequate. In addition to the discomfort and distress caused by pain, it is frequently the underlying cause of behavioural symptoms, which can lead to inappropriate treatment with antipsychotic medications. Your doctor should consider prescribing paracetamol if there is clinical suspicion that pain is a relevant trigger.

More information\ decision support material

Common pain behaviours in cognitively impaired elderly persons according to the AGS Panel on persistent pain in older persons.

Routine screening programmes do not exist for dementia. If you think that you or someone you care for are displaying symptoms you should speak to your doctor.

The NHS choices website on dementia gives more information on spotting symptoms and what do next.

Antipsychotics can cause serious side effects in patients with Lewy Body Dementia.

They should only be used under expert guidance.

More information\ decision support material

LDBA information sheet

Anticholinergic drugs can be detrimental to cognition in later life and have other serious side effects.

Careful consideration of the risks to patients, including the use of an anticholinergic burden scale, should be undertaken prior to initiation.

More information\ decision support material

NHS England toolkit

If your depression is being treated with antidepressants as prescribed by your doctor and you do not feel that these are effective, your medication should be changed or another medication added, which will work in parallel with the initial drug that was prescribed.

For more information on antidepressants see the NHS choices website.

The NHS also has a decision aid to help you decide with your doctor what course of action is best for you.

Sometimes, being maintained on life support will not result in a recovery that is meaningful to you. Similarly if you are caring for someone in this situation you should have a discussion with the patient (if that’s possible) as well as with specialist clinicians about the goals that can be achieved through further treatment.

NHS choices website has an end of life care guide to provide you with more information on planning for end of life care.

If you are particularly frail or have been told you have less than a year to live you should try to decrease the number of medicines you take to only those used to control your symptoms.

The NHS Choices website has lots of information on end of life care and your wellbeing, to help you make the right decisions about your care.

Fainting spells are common and most patients will not need tests such as electrical scans of your brain – these should only be used after a thorough clinical assessment.

You should only be considered for medication to treat high blood pressure, to prevent heart disease and stroke, if you have other risk factors and blood pressure readings consistently above 140-159/90-99.

For more information on high blood pressure see the NHS Choices website.
The NHS also has a decision aid to help you decide with your doctor what course of action is best for you. 

If you are taking a statin, which are often prescribed to lower levels of low-density lipoprotein (also known as ‘bad cholesterol’) at the recommended dose, you do not need to have your cholesterol levels routinely checked unless you have had pre-existing conditions such as a heart attack, stroke or a family tendency towards problems with high lipids.

For more information on high cholesterol see the NHS website.
There is also a NICE decision aid for helping to reduce cardiovascular disease including lipid modification which may asssit discussions with your doctor.

You don’t always need a blood transfusion if you’re iron deficient.

More information\ decision support material

Leaflets are available through the NHSBT website

Anaemia patient Information leaflet October 2016

Iron in your diet

Some injuries, such as hip and shoulder dislocations, can be treated under medications which make you feel a little drowsy (sedation) rather than put you to sleep (general anaesthetic). This means you may not have to go to the operating theatre and can be treated in the A&E.

The NHS choices website has more information on dislocated shoulders and dislocated kneecaps.
It also provides full explanations of anaesthetics.

Scans are usually not helpful for low back pain, even if you have sciatica.

If you are over 45, you do not usually need blood tests to diagnose the menopause. Typical symptoms include hot flushes and sweats and your periods may be much lighter or irregular in nature.

The NHS choices website provides full information on identifying symptoms and treatments for the menopause.

Migraine is common, and unless there are unusual features, you will probably not need any brain imaging to diagnose it.

Genetic testing is often not necessary when experiencing recurrent miscarriage

If you have had recurrent miscarriages in the past, you should be offered investigations to see if there is an underlying cause.  In the majority of cases no underlying cause will be found and most couples under these circumstances will go on to have a successful pregnancy. Unless you have lost a baby with an inherited chromosomal abnormality, neither you nor your partner need to have any specific genetic tests. Information should be provided to help you to understand your options and your healthcare professional will discuss your individual circumstance and preferences with you.

More information\ decision support material

Royal College of Obstetricians and Gynaecologists provide detailed information on recurrent and late miscarriage

If you have experienced unexplained or recurrent miscarriages, medicines like aspirin, heparin or progesterone should not be used to reduce the risk of further miscarriages.

The Royal College of Obstetricians and Gynaecologists provide detailed information on bleeding and/or pain in early pregnancy and recurrent and late miscarriages.

The care of frail older adults with complex needs who need an inpatient admission, is best managed in an older person’s specialist ward environment.

There is a transition towards ‘ageless services’ across many trusts in the UK whereby many patients in later life are being managed on mixed wards and are often neglected in these settings.

More information/ decision support material

Depression in older adults

Mental Health in the Community

Patients should not be refused access to a service, investigation or treatment solely on the basis of their age. Decisions should be based on need

More information/ decision support material

NICE guidance

Mental health in later life

Management of older adults admitted with mental problems should be guided by old Age specialists, who are able to manage the complex needs of this population.

There is a transition towards ‘ageless services’ across many trusts in the UK whereby many patients in later life are being managed on mixed wards and are often neglected in these settings.

More information/ decision support material

NICE guideline

Mental Health Foundation

Clinicians should not use physical restraints in older adults in hospital settings with delirium except as a last resort.

There is little evidence to support the effectiveness of physical restraints to manage people with delirium who exhibit behaviours that risk injury. Physical restraints can lead to serious injury or death and may worsen agitation and delirium. Restraints should therefore be used as a last resort and should be discontinued at the earliest possible time, particularly given that effective non-pharmacological alternatives are available.

More information/ decision support material

NICE Guideline

Patient info

If benzodiazepines or antipsychotics drugs have been initiated during an acute care hospital admission, make sure there is a clear plan to review their use, ideally tapering and discontinuing prior to discharge.

Both benzodiazepines and antipsychotics have serious side effects in the elderly, in particular, addiction, falls, worsening cognition, infections, stroke and death.

 

More information/ decision support material

Choosing Wisely Canada toolkit

Patient Info

NHS Wales

Royal College of Psychiatrists

Bisphosphonates are drugs that help reduce fracture risk due to bone thinning (osteoporosis). People who take bisphosphonate treatment should discuss this with their healthcare professional every 3-5 years because it may be advisable for some to have a break in treatment.

More information\ decision support material

National Osteoporosis Society

If you have a simple ovarian cyst of less than 5cm in diameter, and have not undergone the menopause, you are unlikely to need a follow up appointment or have levels of a protein called Ca-125 checked.

The Royal College of Obstetricians and Gynaecologists provide detailed information on ovarian cysts before the menopause.

If your doctor suspects you may have polycystic ovaries, you should have a blood test to look for the typical hormone pattern before further investigations.

The Royal College of Obstetricians and Gynaecologists provide detailed information on what polycystic ovaries mean for your long-term health.

If you are pregnant, aspirin is not recommended as a way of reducing the chances of developing blood clots (thromboprophylaxis).

NHS Choices website provides more information on aspirin.

Unless you have diabetes or develop gestational diabetes during pregnancy, ultrasound scans should not be used to check if your baby is bigger than normal for its gestational age (macrosomia).

The Royal College of Obstetricians and Gynaecologists provide detailed information on gestational diabetes.

When a baby in the womb is lying bottom or feet first (in breech position), it can often be turned while in the womb, without the need for a caesarean section

If your baby is lying in a breech position in the uterus after 36 weeks of your pregnancy (lying bottom first or feet first) you have three options. These are either turning the baby in the uterus, a vaginal breech birth or a planned Caesarean section. If you do want to have a vaginal birth, you should first be offered the option of trying to turn your baby. This is a safe option and may help to avoid the need for a Caesarean section if you don’t want one. Information should be provided to help you to understand your options and your healthcare professional will discuss your individual circumstance and preferences with you.

More information/ decision support material

Royal College of Obstetricians and Gynaecologists provide detailed information on this: https://www.rcog.org.uk/en/patients/patient-leaflets/breech-baby-at-the-end-of-pregnancy/

Electronic monitoring of your baby’s heart is only needed during labour if you have a higher than normal risk of complications.

The NHS Choices website has more information on the stages of labour. 

Nausea and vomiting in pregnancy is very common and most women are able to manage this by eating and drinking frequently

In some cases women will still need further treatment and this can be provided by your GP. Medication for sickness in pregnancy is safe and will not harm your baby. Sometimes hospital referral will be recommended, especially if you are very dehydrated. In hospital you will be offered rapid rehydration and medication which will mean that you can go home on the same day as you have been admitted. Information should be provided to help you to understand your options and your healthcare professional will discuss your individual circumstance and preferences with you.

More information/ decision support material

Royal College of Obstetricians and Gynaecologists provide detailed information nausea and vomiting in pregnancy: https://www.rcog.org.uk/en/patients/patient-leaflets/pregnancy-sickness/

If you are planning a pregnancy or may be pregnant, you should not be prescribed sodium valproate for the treatment of epilepsy, migraine or bipolar disorder unless other medications are not working. If sodium valproate is prescribed, this should only be done after a full discussion of the risks and benefits to you and your unborn child.

More information on taking valproate while pregnant can be read in the Valproate patient guide.

Unless you are at risk of prostate cancer because of race or family history, testing for a specific protein produced by the prostate (Prostate Specific Antigen – PSA) does not necessarily lead to a longer life.

There is a misperception that early testing of PSA is always of benefit in detecting prostate cancer in its early stages. There are important trade-offs between the potential benefits and harms involved with either testing or not testing for prostate cancer and a lack of evidence on testing outcomes. Potential benefits include earlier diagnosis of prostate cancer but potential harms include additional hospital visits, tests, anxiety and over diagnosis (the identification of prostate cancer that would never have caused symptoms in the patient’s lifetime, leading to unnecessary treatment and associated adverse effects). It is particularly important that patients make informed decisions about the value of having the test.

The NHS decision aid can help you decide with your doctor if the PSA test is the right choice for you. 
Prostate Cancer UK provide more information on the PSA test

Scans of the head (CT or MRI) can only be used to help diagnose psychosis in specific situations and are not necessary or useful in every case.

The NHS Choices website has more information on psychosis. 

Patients who have suspected long standing retinal holes do not need to have laser treatment if they don’t have any symptoms.
For more information on retinal holes see the NHS choices website

If a doctor suspects that you have rheumatoid arthritis, it is recommended that you are referred to rheumatology without delay, even before any tests are done.  There is no single blood test which can determine whether someone does or does not have rheumatoid arthritis.

 

More information\ decision support material

Arthritis Research UK: Rheumatoid Arthritis (2014)

National Rheumatoid Arthritis Society (NRAS): Getting an early diagnosis

NRAS: What is RA? (2014)

NRAS: Inflammatory Arthritis Patient Pathway

NRAS: Managing CVD risk in RA – Love your heart

NRAS: Have you got the S factor? (2011)

NRAS: Laboratory tests used in the diagnosis and monitoring of rheumatoid arthritis (2013)

When discussing treatment for adult schizophrenia with your doctor or specialist nurse, you or your advocate should consider whether medications taken by mouth or longer-acting medications given by injection are most appropriate to you.

The NHS Choices website has more information on the treatment of schizophrenia. 

There are conflicting reports regarding the risks and benefits of statin use. Informed discussion with health professionals will help identify patients for whom statin prescription is appropriate.

More information/ decision support material

NICE CG181 patient decision aid

It is recommended that you have a conversation with your healthcare professional before accepting steroid injections for non-inflammatory musculoskeletal conditions. So that you can make an informed decision, this discussion should include the risks, benefits, and alternatives such as exercise and physical activity. Although some people may experience short term benefit, there are potential long-term risks with repeated injections.

More information/ decision support material

NHS Right Care – Shared Decision Making: Osteoarthritis of the knee (2017)

When you are considering having surgery, you should be informed of your options and be given the chance to discuss the potential benefits and the potential harm of having the procedure. Your age, type of surgery and medical conditions may place you at a higher risk of developing complications or even death. Where this is the case it should be identified and you should be supported in making the right decision for you.

If you are having a surgical procedure, day surgery should be considered as the default option and is suitable in many cases (except complex procedures). Day surgery allows for a quicker recovery with less disruption to you and your home life and also cuts the risk of hospital acquired infections.
The British Association of Day Surgery gives information to help you prepare for day surgery. 

You do not need to come into hospital the day before surgery, if you have had the appropriate preparation, tests and discussions with your doctor beforehand.

Usually you will not need routine tests before surgeries that are minor or intermediate in nature. National guidelines on testing before an operation should indicate when tests are necessary.

You can improve your chances of a speedy recovery after surgery if you get fit, stop smoking, reduce your alcohol intake and in some cases change your diet if you are overweight in the weeks or months before your surgery.

The NHS choices website provides information on preoperative assessments and hospital admissions.
If you are overweight and need to consider losing weight before surgery, the NHS has a decision aid to help you make the right choice on how to achieve this.

Patients who are diagnosed with anterior uveitis (inflammation in the front part of the eye causing pain, redness and blurring) in one eye for the first time will need treatment but do not usually need investigation unless it recurs.
For more information on uveitis see the NHS Choices website

Endometrial hyperplasia (unusual thickening of the uterus lining) can often be managed without surgery

If you are diagnosed with endometrial hyperplasia, unusual thickening of the uterus lining, it can often be managed without surgery by treating the condition with progesterone. The best way for treatment to be given is by a progesterone intrauterine device. Information should be provided to help you to understand your options and your healthcare professional will discuss your individual circumstance and preferences with you.

More information\decision support material

The patient info website provides detailed information on endometrial hyperplasia: https://patient.info/doctor/endometrial-hyperplasia-pro

Most vaginal discharge is completely normal and does not require being seen by a healthcare professional.

However, if you are experiencing frequent episodes of vaginal thrush you should have the skin around your vagina examined by a doctor or specialist nurse. They should rule out other conditions such as an allergy or low hormones (vaginal oestrogen), rather than start another course of treatment for thrush.

The NHS choices website gives more information on vaginal discharge and the symptoms and treatment of thrush.

It is important for everyone to take Vitamin D supplements during winter. If you have restricted access to sunlight (e.g. if you live in a care home or cover your skin), or have dark skin, it is recommended that you take a supplement all year round.  Vitamin D testing is unlikely to be useful or necessary in most people and future testing is not normally needed for those taking supplements.

 

More information\decision support material

National Osteoporosis Society patient leaflet – Vitamin D supplements and tests (2016)

Public Health England: Health England: Vitamin D-  All you need to know (2014)

NHS Choices: Vitamin D