May 2025
Sleepio is a CBT based online programme to help those with insomnia & must be used during the day, not in the middle of the night when struggling to sleep. Patient’s active participation & consistency is crucial for success of this treatment. More info: https://apps.nhslothian.scot/refhelp/guidelines/mentalhealthadult/mentalhealthpsychologyotherservices/computerised-cognitive-behavioural-therapy-cbt/insomniasleepio/
The Medicine of the Elderly team run the Parkinson’s & Movement disorders service for older people in NHS Lothian. Their RefHelp page has been recently updated with helpful referral points. For detailed info please see: https://apps.nhslothian.scot/refhelp/guidelines/medicineoftheelderlygeriatrics/parkinsons-moe/
NHS Lothian’s Flow Navigation Centre is changing! A phased development plan has been introduced to help enhance the service, improve patient journey & in turn increase performance, particularly in Unscheduled Care. For more info please watch the recording: https://vimeo.com/showcase/11563186/video/1080803582
Mallet finger causes drooping at the fingertip due to tendon or bone injury at the DIP joint. X-ray is needed to guide management—most treated conservatively, a few may need surgery. For further info: https://apps.nhslothian.scot/refhelp/mallet-finger-injury/
DIPJ ganglions aka Mucous cysts are harmless lumps near the DIP joint or nail fold—often resolve on their own. Try simple measures first; surgery is only needed if painful, bursting, or causing nail changes. For further information, see https://apps.nhslothian.scot/refhelp/guidelines/plasticsurgery/handsurgery/mucouscyst/
Mastitis, though usually linked to breastfeeding, can affect non-lactating women. It occurs in 10–33% of breastfeeding mothers, mostly within 2–3 weeks postpartum. Abscess develops in 3–11%, often in the first 6 weeks. See https://apps.nhslothian.scot/refhelp/guidelines/pregnancy/mastitis-lactation/ for management guidance.
Pregnancy MUST be avoided during use of Topiramate because it is a teratogen. Contraception is complicated as Topiramate is an enzyme inducer. Use of highly effective long-acting reversible contraception (LARC) is recommended – more details here: https://apps.nhslothian.scot/refhelp/guidelines/sexualreprohealth/contraception/topiramate-contraception/
Recently updated IBD Page with clearly outlined referral pathway, criteria for admission for known/unknown diagnosis of IBD, & ‘after referral’ info. Please note acutely unwell patients should be referred in directly after contacting the on-call team. https://apps.nhslothian.scot/refhelp/guidelines/gastrointestinal/inflammatoryboweldisease/
Meniere’s disease is characterised by recurrent attacks of severe disabling vertigo, significant unilateral hearing loss, and unilateral tinnitus. Unilateral aural fullness may be experienced by some. Detailed referral guidelines here: https://apps.nhslothian.scot/refhelp/guidelines/entadult/ear/menieresdisease/
All adult patients with unilateral or bilateral hearing loss – with or without tinnitus, but no other red flags – should be referred to Audiology. However, sudden sensorineural hearing loss is an ENT emergency and has a separate pathway. More info on red flag symptoms here: https://apps.nhslothian.scot/refhelp/guidelines/entadult/ear/hearingloss/
Updated info for self & primary care management of ear wax. Please note irrigation should not be used where there is otitis externa, mastoid cavities or a perforated tympanic membrane. Please see the referral criteria for secondary care micro suction here: https://apps.nhslothian.scot/refhelp/guidelines/entadult/ear/ear-wax/
Scottish Government has withdrawn the Scottish Good Practice Statement on ME – CFS from May 2025 & RefHelp will be updated shortly. However, the diagnostic & management approaches remain broadly relevant and were approved by the Lothian GP Sub-Committee. https://apps.nhslothian.scot/refhelp/guidelines/rehabilitation/chronicfatiguesyndromeme/
New Page on Paediatric Endocrinology & Diabetes covering all endocrine conditions except Type 1 Diabetes which is managed by the RHCYP Diabetes team. A reminder that new onset diabetes in this age group is a medical emergency needing same day A&E. More info about the service & referral criteria here: https://apps.nhslothian.scot/refhelp/guidelines/paediatrics/paediatric-endocrinology-diabetes/
Scottish Government has recently changed the prescribing regulations for the treatment of erectile dysfunction (ED) removing the need for a specialist opinion. For further background information and prescribing details please see here: https://apps.nhslothian.scot/refhelp/guidelines/sexualreprohealth/sexual-dysfunctions/erectiledysfunctionnonurological/
