July 2026
Any child presenting with a new/changed headache should be assessed for red/amber flags, & if present, this requires a same-day referral. In most cases, provided growth is good & flags are absent, no further investigation is required. For assessment, management, and referral guidance, see https://apps.nhslothian.scot/refhelp/headachepaeds/
Patients presenting to their GP with difficulties establishing breastfeeding should be signposted to their Health Visitor, Family Nurse or Community Midwife. When additional support is needed, they can refer the family to the Breastfeeding Clinic. see https://apps.nhslothian.scot/refhelp/guidelines/pregnancy/breast-feeding-problems/breastfeeding-problems-with-establishing-breastfeeding/
Congenital hand differences (CHD) occur in around 1 in 600 births. Children can be referred to the hand clinic & managed by a multidisciplinary team. Surgery may be required, & when needed, is usually performed after the age of one. For further info, see https://apps.nhslothian.scot/refhelp/guidelines/plasticsurgery/handsurgery/congenitalhanddifferences/
Updated info on capacity assessment including VOCAL a third sector organisation who help in documentation. Please note a Power of Attorney will not authorise moving a person to a care home against their will. In this case, a Guardianship will be required. https://apps.nhslothian.scot/refhelp/guidelines/mentalhealthadult/older-peoples-mental-health/capacity-assessment/
HbA1c is not reliable for monitoring pre‑diabetes in patients with anaemia, haemoglobinopathies, reduced red‑cell survival (e.g., haemolytic anaemia, splenomegaly), post‑splenectomy, or on renal dialysis; in these cases, use an OGTT. More info here: https://apps.nhslothian.scot/refhelp/guidelines/prediabetes/
New page on ‘Recurrent Infections’ added to Medical Paediatrics section outlining warning signs for immunodeficiency, clinical decision algorithm, and referral guidelines. Detailed info here: https://apps.nhslothian.scot/refhelp/recurrent-infections/
Patients with suspected adrenal disease can be referred to the general endocrine clinics at RIE, WGH or SJH. More details on referral criteria & primary care management here: https://apps.nhslothian.scot/refhelp/guidelines/endocrinology/adrenal/
Recently updated RefHelp page on Depression in Adults including diagnostic criteria, scoring tools, treatment options, referral guidelines, advice on initial & ongoing management in primary care, prescribing and range of self-help resources. Please see: https://apps.nhslothian.scot/refhelp/guidelines/mentalhealthadult/depressionadults/
New Drug Toxicology page will hugely help clinicians looking after those using drugs – advice about how to test, what drugs can be checked for and what the tests mean. More info on interpreting and acting on results here: https://apps.nhslothian.scot/refhelp/drug-toxicology/
FAST team is a multi-disciplinary team providing assessment, treatment & consultancy for individuals with an intellectual disability & a history of offending &/or risk of offending. Service info, referral criteria, professional leaflet & much more here: https://apps.nhslothian.scot/refhelp/forensic-assessment-support-and-treatment-fast-team/
Serum folate levels can fluctuate according to recent dietary intake. Levels at the lower end of the normal range may still suggest deficiency. The most helpful investigation is a dietary history. For detailed advice including a patient leaflet please see: https://apps.nhslothian.scot/refhelp/guidelines/haematology/folatedeficiency/
