A A AText only | Accessibility | Privacy and cookies

Browse site A to Z

Search results

Go To Advanced Search

Hydrocephalus - patient information

Description
Information about hydrocephalus (excess fluid in the brain) in children
Url
/Media/UHS-website-2019/Patientinformation/Childhealth/Hydrocephalus-715-PIL.pdf

Caring for your scar - patient information

Description
This factsheet explains how to care for your scar.
Url
/Media/UHS-website-2019/Patientinformation/Medicinestherapiesandanaesthetics/Caring-for-your-scar-1808-PIL.pdf

Your non-invasive ventilation (NIV) device: A40 Pro - patient information

Description
This factsheet explains how to use and care for your A40 Pro non-invasive ventilation (NIV) device safely at home.
Url
/Media/UHS-website-2019/Patientinformation/Respiratory/Your-non-invasive-ventilation-NIV-device-A40-Pro-3631-PIL.pdf

Your non-invasive ventilation (NIV) device: Lumis 150 - patient information

Description
This factsheet explains how to use and care for your Lumis 150 non-invasive ventilation (NIV) device safely at home.
Url
/Media/UHS-website-2019/Patientinformation/Respiratory/Your-non-invasive-ventilation-NIV-device-Lumis-150-3630-PIL.pdf

Your non-invasive ventilation (NIV) device: Nippy 4 - patient information

Description
This factsheet explains how to use and care for your Nippy 4 non-invasive ventilation (NIV) device safely at home.
Url
/Media/UHS-website-2019/Patientinformation/Respiratory/Your-non-invasive-ventilation-NIV-device-Nippy-4-3627-PIL.pdf

Welcome to Woodland ward special care baby unit - patient information

Description
This leaflet explains what facilities are available to you and your family and what you can expect during your baby's stay on Woodland ward special care baby unit.
Url
/Media/UHS-website-2019/Patientinformation/Neonatal/Welcome-to-Woodland-ward-special-care-baby-unit-3851-PIL.pdf

Anti-VEGF injection treatment - patient information

Description
You have been given this factsheet because your doctor has recommended anti-VEGF injection treatment for your eye condition.
Url
/Media/UHS-website-2019/Patientinformation/Eyes/Anti-VEGF-injection-treatment-1331-PIL.pdf

UHS ISH and IHC request form

Description
Lab use: Barcode Cellular Pathology UKAS reference: 8178 Date: Specimen(s) received: UHS IHC and ISH Request Form Referrer Information Referring clinician Position Hospital Department Departmental email for results Telephone number  NHS  Private Patient Information Surname First Name Date of Birth Gender Hospital number NHS number Address Postcode: Diagnosis Additional information Priority  Urgent  Cancer pathway  Routine Histology / immunophenotyping report MUST be included Please notify the laboratory if clinically urgent Sample details Histology number Block ID Specimen date Tissue type % neoplastic nuclei (Nearest 10%) % necrosis (Nearest 10%, by surface area) Specimen type  Biopsy  Resection/excision  Cell block  Other Fixed in 10% neutral buffered Formalin?  Yes  No If no, please state fixative ………………………………………. Cellular Pathology test request(s) Queries to: UHS.CellPath@nhs.net and/or 02381206443 ✓ Please send: ALK D5F3 immunohistochemistry (2 × USS) • An H&E stained section. ROS1 SP384 immunohistochemistry (2 × USS) • The number of unstained sections listed for each test. PD-L1 22C3 immunohistochemistry (2 × USS) Unstained sections should be 4 μm thick and mounted on PD-L1 28-8 immunohistochemistry (2 × USS) positively-charged glass slides. Recently cut slides are PD-L1 SP142 immunohistochemistry (2 × USS) preferable as antigenicity of cut tissue sections may diminish over time. Non-decalcified tissues should be sent if possible as decalcified tissue can generate false negative results. MMR immunohistochemistry (MLH1, PMS2, MSH2, MSH6) (6 × USS) For endometrial cancers which will require MDT review at UHS, a block should be sent rather than unstained sections. EBER ISH (4 × USS) High risk HPV ISH: (4 x USS + p16 IHC if available) Requester Name Contact details Signature Date // Sample transport The referring laboratory is responsible for the safe transfer of tissue and it is thus recommended that Royal Mail Recorded Delivery or an equivalent tracked postal service is used. Transport tracking ID Please send samples to: Cellular Pathology Department Level E, Mail Point 002 Southampton General Hospital Southampton SO16 6YD University Hospital Southampton NHS Foundation Trust PATHOLOGY DIRECTORATE Cellular Pathology LF 101 024 Revision 2 Page 1
Url
/Media/UHS-website-2019/Docs/Services/Pathology/Cell-path/UHS-ISH-and-IHC-request-form.pdf

InP-PAM-(cycles 5-6) v1

Description
Chemotherapy Protocol Sarcoma DOXORUBICIN-METHOTREXATE (cycles 5-6) Inpatient Regimen There are multiple versions of this protocol in use. Please ensure you have the correct version and prescribe the correct number of cycles. Regimen Sarcoma – InP-Doxorubicin-Methotrexate (cycles 5-6) Indication Operable osteosarcoma Toxicity Drug Cisplatin Doxorubicin Methotrexate Adverse Effect Neuropathy, neurotoxicity, ototoxicity Cardiomyopathy, alopecia, urinary discolouration (red) Stomatitis, conjunctivitis, renal toxicity The presence of a third fluid compartment e.g. ascites, pleural effusion or other oedema may delay the clearance of methotrexate and increase toxicity and should be resolved before methotrexate administration. The adverse effects listed are not exhaustive. Please refer to the relevant Summary of Product Characteristics for full details. Monitoring FBC, LFTs and U&Es (including uric acid and phosphate) prior to day one of treatment Ensure adequate cardiac function before starting therapy. Baseline LVEF should be measured in patients with a history of cardiac problems, cardiac risk factors or in the elderly. Discontinue doxorubicin if cardiac failure develops Methotrexate FBC, LFTs and U&Es prior to day one of treatment GFR measurement either by EDTA or 24 hour urine collection prior to methotrexate infusion. The creatinine clearance must be 50ml/min or more for the methotrexate in this regimen to be administered Methotrexate levels taken every 24 hours starting 24 hours after the end of the infusion until the level is below 0.1micromol/L Version 1 (Sept 2015) Page 1 of 8 Sarcoma-Doxorubicin-Methotrexate (cycles 5-6) Urinary pH every two hours as a minimum until the methotrexate level is below 0.1micromol/L Strict fluid balance chart to be maintained throughout methotrexate administration with appropriate action taken if positive by more than 2kg/L. Dose Modifications The dose modifications listed are for haematological, liver and renal function and drug specific toxicities only. Dose adjustments may be necessary for other toxicities as well. In principle all dose reductions due to adverse drug reactions should not be re-escalated in subsequent cycles without consultant approval. It is also a general rule for chemotherapy that if a third dose reduction is necessary treatment should be stopped. Please discuss all dose reductions / delays with the relevant consultant before prescribing, if appropriate. The approach may be different depending on the clinical circumstances. In this protocol drug dosages should be modified as little as possible. If necessary, delay treatment in order to administer full doses. Decisions regarding the possibility of proceeding with chemotherapy after a delay should be re-evaluated at least every 3-4 days. Haematological Consider blood transfusion or erythropoietin if the patient is symptomatic of anaemia or has a haemoglobin of less than 8g/dL. Doxorubicin Criteria Neutrophil Platelets Eligible Level equal to or more than 0.75x109/L equal to or more than 75x109/L On day one of the cycle containing doxorubicin if the neutrophils are less than 0.75x109/L and / or the platelet count is less than 75x109/L delay treatment for 3-4 days until these criteria are met. Treatment may continue at full dose unless there has been a previous dose reduction. For a repeated delay of more than seven days use growth factors rather than dose reduce. For a NCI-CTC grade 4 (and possible grade 3) febrile neutropenia prescribe growth factors with the next cycle. Methotrexate Methotrexate should only be delayed (no dose reductions apply) until recovery if the neutrophil count is less than 0.25x109/L or the platelets are less than 50x109/L. Version 1 (Sept 2015) Page 2 of 8 Sarcoma-Doxorubicin-Methotrexate (cycles 5-6) Hepatic Impairment There is a higher risk of toxicity in patients with concomitantly impaired renal function, consider dose reduction. Drug Doxorubicin Bilirubin μmol/L less than 30 and 30-50 and/or 51-85 more than 85 AST/ALT units 2-3xULN more than 3xULN N/A N/A Dose (% of original dose) 75% 50% 25% omit Methotrexate less than 50 and 51-85 or more than 85 less than 180 more than 180 N/A 100% 75% omit Transient increases in bilirubin and transaminases, lasting up to two weeks, are likely following methotrexate infusion and should not be considered an indication to stop treatment. Persistent hyperbilirubinaemia (bilirubin above 1.25xULN) and/or grade 3/4 hypertransaminasemia lasting longer than three weeks should result in discontinuation of the drug. Renal Impairment Drug Doxorubicin Creatinine Clearance (ml/min) less than 10 Dose (% of original dose) Consider dose reduction in severe renal failure Methotrexate 50 or greater 100% A creatinine clearance of 50ml/min or more is required to proceed with the methotrexate element of this regimen. Consider the appropriateness of regimen if dose reductions due to impaired renal function are required for other agents. Other Doxorubicin If the LVEF is less than 50% or the SF less than 28% repeat the ECHO or MUGA in seven days. If this is within normal limits continue with chemotherapy. If the LVEF does not normalise omit all further doxorubicin. Regimen 28 day cycle for 2 cycles, following on from four cycles of the cisplatin containing regimen Version 1 (Sept 2015) Page 3 of 8 Sarcoma-Doxorubicin-Methotrexate (cycles 5-6) Body surface area should be calculated from a standard nomogram. Do not attempt to correct for amputation. Patients should be re-weighed after surgery and the body surface area recalculated. Drug Doxorubicin Methotrexate Dose Days 37.5mg/m2 1,2 12000mg/m2 15, 22 Administration Intravenous infusion in 48ml sodium chloride 0.9% over 24 hours Intravenous infusion in 1000ml sodium chloride 0.9% over 4 hours Dose Information Doxorubicin will be dose banded according to the agreed bands The maximum lifetime cumulative dose of doxorubicin is 450mg/m². However prior radiotherapy to the mediastinal / pericardial area should receive a lifetime cumulative doxorubicin dose of no more than 400mg/m². Methotrexate (intravenous) will be dose banded according to the agreed bands Administration Information Extravasation Doxorubicin – vesicant Methotrexate – inflammitant Other A central line must be in place to administer the doxorubicin The methotrexate infusion must not be started until the urinary pH is above 7. This urinary pH must be maintained throughout the methotrexate infusion and until the methotrexate level is 0.1micromol/L or below Additional Therapy This is an inpatient regimen please ensure all supportive and take home medicines are prescribed on the inpatient chart or general electronic prescribing system. Doxorubicin Antiemetics Starting 15-30 minutes prior to chemotherapy - dexamethasone 4mg twice a day for 3 days oral or intravenous - metoclopramide 10mg three times a day for 3 days and then 10mg when required oral or intravenous Version 1 (Sept 2015) Page 4 of 8 Sarcoma-Doxorubicin-Methotrexate (cycles 5-6) Methotrexate Hydration The following fluid regimen is recommended as hydration. Fluid hydration should start at least six hours prior to methotrexate. This schedule should be repeated every 12 hours until the methotrexate level is below 0.1 micromol/L - Furosemide 40mg once only dose when required for the treatment of fluid overload or to maintain urine output oral or intravenous bolus - Sodium chloride 0.9% with 20mmol potassium chloride 1000ml intravenous infusion over 240 minutes with 50-100mmol sodium bicarbonate adjusted to maintain urinary pH above 7 - Glucose 5% with potassium chloride 27mmol 1000ml intravenous infusion over 240 minutes with 50-100mmol sodium bicarbonate adjusted to maintain urinary pH above 7 - Sodium chloride 0.9% with 20mmol potassium chloride 1000ml intravenous infusion over 240 minutes with 50-100mmol sodium bicarbonate adjusted to maintain urinary pH above 7 - Sodium chloride 0.9% with 20mmol potassium chloride 1000ml intravenous infusion over 240 minutes with 50-100mmol sodium bicarbonate adjusted to maintain urinary pH above 7 - Glucose 5% with potassium chloride 27mmol 1000ml intravenous infusion over 240 minutes with 50-100mmol sodium bicarbonate adjusted to maintain urinary pH above 7 Antiemetics Starting 15-30 minutes prior to intravenous methotrexate - dexamethasone 4mg twice a day for 3 days oral or intravenous - metoclopramide 10mg oral three times a day for three days then 10mg three times a day when required - ondansetron 8mg twice a day for 3 days oral or intravenous Post-treatment with intravenous methotrexate - folinic acid 30mg every 3 hours intravenous bolus beginning 24 hours after the start of the methotrexate infusion and continued until the methotrexate levels are below 0.1micromol/L. This may be given orally from dose 5 onwards if the patient is able to tolerate oral therapy. If levels of methotrexate are above 2micromol/L additional folinic acid may be necessary. See advice from a senior member of staff. Mouthcare for the prophylaxis or treatment of mucositis in accordance with local guidelines Gastric protection with a proton pump inhibitor or a H2 antagonist may be considered in patients considered at high risk of GI ulceration or bleed. Version 1 (Sept 2015) Page 5 of 8 Sarcoma-Doxorubicin-Methotrexate (cycles 5-6) Additional Information A significant number of drugs interact with intravenous methotrexate. At the doses used in this protocol this can lead to significant toxicity or reduction in efficacy. Always check for drug interactions before prescribing any additional medication. Coding Procurement – X71.5 Delivery – not required References 1. Ferrari S, Ruggieri P, Cefalo G et al. Neoadjuvant chemotherapy with methotrexate, cisplatin and doxorubicin with or without ifosfamide in non-metastatic osteosarcoma of the extremity. An Italian sarcoma group trial ISG/OS-1. J Clin Oncol 2012; 30 (17): 2112-2118. 2. Ferrari S, Meazza C, Palmerini E et al. Non-metastatic osteosarcoma of the extremity. Neoadjuvant chemotherapy with methotrexate, cisplatin, doxorubicin and ifosfamide. An Italian Sarcoma Group Study (ISG/OS-OSS). Tumori 2014; 100 (6): 612619. Version 1 (Sept 2015) Page 6 of 8 Sarcoma-Doxorubicin-Methotrexate (cycles 5-6) REGIMEN SUMMARY InP-Doxorubicin-Methotrexate (cycles 5-6) Other than those listed below, supportive medication for this regimen will not appear in Aria as prescribed agents. The administration instructions for each warning describes the agents which must be prescribed on the in-patient chart or general electronic prescribing system Day 1, 2 (Doxorubicin) 1. Warning – Check supportive medicines Administration Instructions 1. Dexamethasone 4mg twice a day, days 1 to 3 oral or intravenous 2. Metoclopramide 10mg three times a day, days 1 to 3 then 10mg three times a day when required oral or intravenous 3. Consider gastric protection 4. Consider mouthwashes 2. Doxorubicin 37.5mg/m2 intravenous infusion in 48ml sodium chloride 0.9% over 24 hours Day 15, 22 (Methotrexate) 1. Warning – Check supportive medication prescribed Administration Instructions 1. Furosemide 40mg oral or intravenous 2. Fluids repeated on a 12 hourly cycle to maintain fluid balance, urine output and pH above 7 until methotrexate level is below 0.1micromol/L - sodium chloride 0.9% with potassium chloride 20mmol 1000ml intravenous infusion over 240 minutes with 50-100mmol sodium bicarbonate adjusted to maintain urinary pH above 7 - glucose 5% with potassium chloride 27mmol1000ml intravenous infusion over 240 minutes with 50-100mmol sodium bicarbonate adjusted to maintain urinary ph above 7 - sodium chloride 0.9% with potassium chloride 20mmol 1000ml intravenous infusion over 240 minutes with 50-100mmol sodium bicarbonate adjusted to maintain urinary pH above 7 - sodium chloride 0.9% with potassium chloride 20mmol 1000ml intravenous infusion over 240 minutes with 50-100mmol sodium bicarbonate adjusted to maintain urinary pH above 7 - glucose 5% with potassium chloride 27mmol 1000ml intravenous infusion over 240 minutes with 50-100mmol sodium bicarbonate adjusted to maintain urinary ph above 7 3. Dexamethasone 4mg twice a day for 3 days oral or intravenous 4. Metoclopramide 10mg three times a day for 3 days and then 10mg three times a day when required oral or intravenous 5. Ondansetron 8mg twice a day for 3 days oral or intravenous 6. Folinic acid 30mg every 3 hours intravenous beginning 24 hours after the start of the methotrexate infusion and continued until the methotrexate levels are below 0.1micromol/L. This may be given orally from dose 5 onwards 7. Consider gastric protection 8. Consider mouthwashes 2. Methotrexate 12000mg/m2 intravenous infusion in 1000ml sodium chloride 0.9% over four hours Version 1 (Sept 2015) Page 7 of 8 Sarcoma-Doxorubicin-Methotrexate (cycles 5-6) DOCUMENT CONTROL Version Date Amendment Written By Approved By 1 Sept 2015 None Dr Deborah Wright Pharmacist Dr Nicola Keay Consultant Medical Oncologist This chemotherapy protocol has been developed as part of the chemotherapy electronic prescribing project. This was and remains a collaborative project that originated from the former CSCCN. These documents have been approved on behalf of the following Trusts; Hampshire Hospitals NHS Foundation Trust NHS Isle of Wight Portsmouth Hospitals NHS Trust Salisbury NHS Foundation Trust University Hospital Southampton NHS Foundation Trust Western Sussex Hospitals NHS Foundation Trust All actions have been taken to ensure these protocols are correct. However, no responsibility can be taken for errors which occur as a result of following these guidelines. Version 1 (Sept 2015) Page 8 of 8 Sarcoma-Doxorubicin-Methotrexate (cycles 5-6)
Url
/Media/UHS-website-2019/Docs/Chemotherapy-SOPs1/Sarcoma/InP-PAM-cycles-5-6-v1.pdf

Subconjunctival haemorrhage - patient information

Description
A subconjunctival haemorrhage is a small bleed (similar to a bruise) from one of the minor blood vessels on the surface of the eye.
Url
/Media/UHS-website-2019/Patientinformation/Eyes/Subconjunctival-haemorrhage-1389-PIL.pdf
1 to 10 of 112
Previous 1 2 3 4 5 … Next