The document discusses weight loss surgery as a solution for people who have tried everything else to lose weight but have had long-term failure. It describes the local BMI hospital as providing personal care and support from specialists before, during, and after treatment to help patients stay healthy and achieve the best results. It encourages readers to contact the hospital soon to change their life for the better.

1. Weight Loss Surgery
Life
changing
more
ways
than
one
Being overweight can
cause all sorts of health problems,
and the more overweight you are the more
serious they can be. If you’ve tried everything to
lose weight, and nothing has really worked for long,
weight loss surgery could be the solution for you. Experts in weight loss surgery
At your local BMI hospital, you will receive personal
ongoing care and support from a team of specialists before,
during and long after treatment to help you stay healthy and
achieve the best possible results.
Come and see us soon - and change your life for the better.
Telephone: 0800 404 66 95 www.bmiweightloss.co.uk

2. Early detection of potential health problems through health screening can reduce sickness
absence and make big savings for your business.
Experts in Health Assessment
Intelligent Health from BMI, the UK’s largest independent healthcare provider, offers a choice of
5 different levels of cost-effective health screening for all your employees.
To find out which one would benefit your business the most, call us on 0808 101 0366 or email
business@bmihealthcare.co.uk
After all, a healthy team is a productive team.

3. Reliable protection that fits her lifestyle
Look after her bones so she can enjoy
the things in life that make her feel good ibandronic acid
Supporting her every step of the way
Prescribing information ing requirements. Pregnancy/Lactation: Do not use. Side effects:
Bonviva® (ibandronic acid) 150mg tablet. See SmPC before prescribing. Indication: See SmPC for full details. Common: Dyspepsia, nausea, abdominal pain, diarrhoea, flatulence,
Treatment of osteoporosis in postmenopausal women at increased risk of fracture. A reduction reflux, oesophagitis, headache, influenza-like syndrome, fatigue, myalgia, arthralgia, rash, mus-
in the risk of vertebral fractures has been demonstrated, efficacy on femoral neck fractures has cle cramp, musculoskeletal pain/stiffness. Rare but potentially serious: angio-edema and hyper-
not been established. Dosage and administration: 150mg once monthly, swallowed sensitivity reactions. Osteonecrosis of the jaw has been reported with IV and oral bisphospho-
whole whilst sitting or standing with plain water after overnight (>6 hours) fast. Maintain fast nates. Legal Category: POM. Presentation and Basic NHS Cost: Oral - Bonviva
(including other medications), do not lie down for 1 hour after administration. Contra-indi- 150mg tablet blister pack x 1 £21.45, 150mg tablet blister pack x 3 £64.35. MA Nos:
cations: Hypocalcaemia, hypersensitivity to any ingredient. Precautions: Treat hypocal- EU/1/03/265/003, EU/1/03/265/004. MA Holder: Roche Registration Limited, 6
caemia and other disturbances of bone and mineral metabolism before starting Bonviva. Ensure Falcon Way, Shire Park, Welwyn Garden City AL7 1TW, United Kingdom. Bonviva is a registered
adequate intake of calcium and vitamin D. Not recommended if creatinine clearance <30ml/min trade mark.Date of Preparation: September 2006.
or if serum creatinine >200Ìmol/l (2.3mg/dl). Potential for oropharyngeal ulceration and
Information about adverse event reporting can be found at
upper GI disturbance. Follow dosing instructions especially if there is a history of prolonged
www.yellowcard.gov.uk Adverse events should be reported
oesophageal transit time. Caution with NSAIDs. Invasive dental procedures should be avoided in
to Roche products Limited.
patients receiving bisphosphonates if possible. Interactions: Metabolic interactions are consid-
Please contact UK Drug Safety Centre on: 01707 367554.
ered unlikely as ibandronic acid does not inhibit major hepatic P450 isoenzymes. Observe fast-
Date of preparation: November 2007

4. Actively protects and supports bones
1
where it matters most
Bonviva belle: Margaret, 56
january february march april may june july august september october november december
Prescribing information
Bonviva® (ibandronic acid) 150mg tablet. See SmPC before prescribing. Indication: Treatment of osteoporosis in postmenopausal women at
increased risk of fracture. A reduction in the risk of vertebral fractures has been demonstrated, efficacy on femoral neck fractures has not been established.
Dosage and administration: 150mg once monthly, swallowed whole whilst sitting or standing with plain water after overnight (>6 hours) fast.
Bonviva gives her reassurance for her
Maintain fast (including other medications), do not lie down for 1 hour after administration. Contra-indications: Hypocalcaemia, hypersensitivity to
any ingredient. Precautions: Treat hypocalcaemia and other disturbances of bone and mineral metabolism before starting Bonviva. Ensure adequate
intake of calcium and vitamin D. Not recommended if creatinine clearance <30ml/min or if serum creatinine >200Ìmol/l (2.3mg/dl). Potential for
osteoporosis, so now all she has to worry
oropharyngeal ulceration and upper GI disturbance. Follow dosing instructions especially if there is a history of prolonged oesophageal transit time. Caution
with NSAIDs. Invasive dental procedures should be avoided in patients receiving bisphosphonates if possible. Interactions: Metabolic interactions are
considered unlikely as ibandronic acid does not inhibit major hepatic P450 isoenzymes. Observe fasting requirements. Pregnancy/Lactation: Do not
about is winning first prize for her daffs
use. Side effects: See SmPC for full details. Common: Dyspepsia, nausea, abdominal pain, diarrhoea, flatulence, reflux, oesophagitis, headache, influen-
za-like syndrome, fatigue, myalgia, arthralgia, rash, muscle cramp, musculoskeletal pain/stiffness. Rare but potentially serious: angio-edema and hyper-
sensitivity reactions. Osteonecrosis of the jaw has been reported with IV and oral bisphosphonates. Legal Category: POM. Presentation and Basic
at the village show
NHS Cost: Oral - Bonviva 150mg tablet blister pack x 1 £21.45, 150mg tablet blister pack x 3 £64.35. MA Nos: EU/1/03/265/003,
EU/1/03/265/004. MA Holder: Roche Registration Limited, 6 Falcon Way, Shire Park, Welwyn Garden City AL7 1TW, United Kingdom. Bonviva is
a registered trade mark. Date of Preparation: September 2006.
Reference:
1. Bonviva 150mg Summary of Product Characteristics, October 2006.
Information about adverse event reporting can be found at www.yellowcard.gov.uk
Adverse events should be reported to Roche products Limited.
Please contact UK Drug Safety Centre on: 01707 367554.
Date of preparation: November 2007.
ibandronic acid
Providing strength from within

5. Gimme 5
Just one of the devastating effects of RSV is the demand
it places on paediatric beds - at a local cost of over
£100,000 per year.
With Synagis, just five injections can help to keep RSV at
arms length.
It’s worth thinking about.
The impact of RSV demands it

6. 5 simple steps to preventing RSV.
Just one of the devastating effects of RSV is the demand
it places on paediatric beds - at a local cost of over
£100,000 per year.
With Synagis, just five injections can help to stamp
out RSV.
It’s worth thinking about.
The impact of RSV demands it

7. Brandwriting
PAN Advertising Ltd. Eton House 18-24 Paradise Road Richmond upon Thames Surrey TW9 1SE Tel: 020 8948 2020 Fax: 020 8948 8181 www.pancomms.com

8. pen wide
with AquaFresh Isoactive

9. FOR PERSONAL GROWTH AND UNDERSTANDING

10. sratch
Scratch
beneath
beneath
the surface…
the surface...
He’s not in any trouble but his
relationship with his family is strained
AreAre his emerging needs beingneeds
his emerging met?
being met?
STRATTERA*▼(ATOMOXETINE) ABBREVIATED PRESCRIBING INFORMATION Presentation Hard capsules: 10mg, 18mg, 25mg, QT or a family history of QT prolongation. Discontinue in patients with jaundice or laboratory evidence of liver injury, and do not restart. on the cardiovascular system can be potentiated. There is the potential for an increased risk of QT interval prolongation when be considered potentially related to atomoxetine. No serious safety concerns were observed during acute or long-term treatment. The
40mg, or 60mg atomoxetine. Uses Treatment of Attention-Deficit/Hyperactivity Disorder (ADHD) in children 6 years of age and older, Use with caution in patients with hypertension, tachycardia, or other cardiovascular disease. Pulse and blood pressure should be atomoxetine is administered with other QT prolonging drugs, (such as neuroleptics, class IA and III anti-arrhythmics, moxifloxacin, following data is from clinical trials in adults: Very common (≥10%): Appetite decreased, insomnia, dry mouth, nausea. Common (≥1-
and in adolescents, as part of a comprehensive treatment programme. Treatment must be initiated by a specialist in the treatment of measured periodically while on therapy. Growth and development should be monitored during treatment with atomoxetine. erythromycin, methadone, mefloquine, tricyclic antidepressants, lithium, or cisapride) drugs that cause electrolyte imbalance (such as <10%): Early morning awakening, libido decreased, sleep disorder, dizziness, middle insomnia, sinus headache, palpitations,
ADHD. In adolescents whose symptoms persist into adulthood and who have shown clear benefit from treatment, it may be appropriate Consideration should be given to dose reduction or interrupting therapy in patients who are not growing or gaining weight satisfactorily. thiazide diuretics), and drugs that inhibit CYP2D6. Caution is advised with concomitant use of medicinal drugs which are known to lower tachycardia, hot flushes, abdominal pain, constipation, dyspepsia, flatulence, dermatitis, sweating increase, difficulty in micturition,
to continue treatment into adulthood. When continuing atomoxetine beyond 1 year, re-evaluation of the need for therapy is Patients requiring long-term therapy should be carefully monitored. Suicide-related behaviour (suicide attempts and suicidal ideation) the seizure threshold (such as antidepressants, neuroleptics, mefloquine, bupropion, or tramadol). Atomoxetine should be used urinary hesitation, urinary retention, dysmenorrhoea, ejaculation disorder, ejaculation failure, erectile disturbance, impotence,
recommended. Initiation in adults is not appropriate. Dosage and Administration For oral use, administered as a single daily dose in has been reported in patients treated with atomoxetine. In double-blind clinical trials, suicide-related behaviours occurred at a frequency cautiously with pressor agents and drugs that affect noradrenaline. Atomoxetine did not cause clinically significant inhibition or induction menstruation irregular, orgasm abnormal, prostatitis, fatigue, lethargy, rigors, weight decreased. Uncommon (≥0.1-<1%): Peripheral
the morning, with or without food. Some patients may benefit from taking it twice daily in divided doses. May be taken with or without of 0.44% in atomoxetine-treated patients, with no events in the placebo group. Hostility and emotional lability were more frequently of cytochrome P450 enzymes. Pregnancy and Lactation Should not be used during pregnancy unless the potential benefit justifies the coldness. Undesirable Effects (Post-Marketing Surveillance) Seizure, QT interval prolongation, Raynaud’s phenomenon, abnormal
food and can be discontinued without dose tapering. Dosing of children/adolescents up to 70 kg body weight: Initiate at a total daily dose observed in clinical trials among children and adolescents treated with atomoxetine compared to those treated with placebo. Patients potential risk to the foetus. Due to lack of data, atomoxetine should be avoided during breast-feeding. Driving, etc Use caution when liver function tests, jaundice, hepatitis, suicide-related events, aggression, hostility, emotional lability, priapism. For full details of these
of approximately 0.5mg/kg and maintain for a minimum of 7 days prior to upward dose titration according to clinical response and who are being treated for ADHD should be carefully monitored for the appearance or worsening of suicide-related behaviour, hostility, driving or operating hazardous machinery. Undesirable Effects (Clinical Trial Reporting) Children and Adolescents Mild to moderate and other side-effects, please see the Summary of Product Characteristics, which is available at http://emc.medicines.org.uk/. Legal
tolerability. The recommended maintenance dose is approximately 1.2mg/kg/day. The safety of single doses over 1.8mg/kg/day and and emotional lability. Introduce with caution in patients with a history of seizure. Discontinuation of atomoxetine should be considered gastro-intestinal disturbance (abdominal pain, decreased appetite, nausea) and sedation are the most common adverse events but Category POM Marketing Authorisation Numbers 00006/0375, 00006/0376, 00006/0377, 00006/0378, 00006/0379 Basic NHS Cost
total daily doses above 1.8mg/kg have not been systematically evaluated. Dosing of children/adolescents over 70 kg body weight: in any patient developing a seizure or if there is an increase in seizure frequency where no other cause is identified. As with other seldom lead to drug discontinuation as the effects are usually transient and tolerable. Some patients lose weight early in therapy. With £15.02 per pack of 7 (10mg, 18mg, 25mg, 40mg), £60.06 per pack of 28 (10mg, 18mg, 25mg, 40mg, 60mg). Date of Preparation or
Initiate at a total daily dose of 40mg and maintain for a minimum of 7 days prior to upward dose titration according to clinical response psychotropic medications, the possibility of rare, serious psychiatric adverse events cannot be excluded. Interactions Should not be continued treatment, differences in growth (height and weight) are clinically insignificant. In adult and paediatric clinical trials, patients Last Review January 2007 Full Prescribing Information is Available From Eli Lilly and Company Limited Lilly House, Priestley Road
and tolerability. The recommended maintenance dose is 80mg. The maximum recommended total daily dose in children and used in combination with monoamine oxidase inhibitors (MAOIs) and should not be used within 2 weeks of discontinuing therapy with experienced mild increases in heart rate and blood pressure. The following is based on data from clinical trials in child and adolescent Basingstoke, Hampshire, RG24 9NL Telephone: Basingstoke (01256) 315 999 *STRATTERA (atomoxetine) is a trademark of Eli Lilly
adolescents over 70 kg and adults is 100mg. For patients with a known poor metaboliser genotype (CYP2D6 poor metabolisers), a lower a MAOI. Treatment with a MAOI should not be initiated within 2 weeks of discontinuing atomoxetine. Dose adjustment and slower patients: Very common (≥10%): Appetite decreased, abdominal pain, vomiting. Common (≥1-<10%): Influenza, anorexia (loss of and Company.
starting dose and slower up titration of the dose may be considered. Special Populations Doses may need to be modified in patients titration of atomoxetine may be necessary in those patients who are also taking CYP2D6 inhibitor drugs (eg, SSRIs, quinidine, appetite), early morning awakening, irritability, mood swings, dizziness, somnolence, mydriasis, constipation, dyspepsia, nausea,
with hepatic insufficiency or renal disease. Atomoxetine should not be used in children under 6 years of age. Contra-indications terbinafine). Caution is advised when combining atomoxetine with potent inhibitors of cytochrome P450 enzymes other than CYP2D6 dermatitis, pruritus, rash, fatigue, weight decreased. Uncommon (≥0.1-<1%): Suicide-related events, aggression, hostility, emotional Information about adverse event reporting can be found at www.yellowcard.gov.uk
Hypersensitivity to atomoxetine or any of the excipients. Should not be used in patients with narrow angle glaucoma. Warnings and in patients who are poor CYP2D6 metabolisers. Atomoxetine should be administered with caution to patients being treated with high lability, palpitations, sinus tachycardia. In trials lasting up to ten weeks, weight loss was more pronounced in poor metabolisers. Adults Adverse events should also be reported to Eli Lilly and Company Limited (Tel. no. 0870 240 1125)
Special Precautions Uncommonly, allergic reactions have been reported. Use with caution in patients with congenital or acquired long dose nebulised or systemically administered (oral or intravenous) salbutamol (or other beta2 agonists) because the action of salbutamol Adverse events reported most frequently were gastro-intestinal or genitourinary. Urinary retention or urinary hesitancy in adults should

11. well adjusted and coping?
Well adjusted and coping?
He seems to be doing OK at school,
but is he really reaching his potential?
Are his emerging needs
Are his emerging needs being met?
being met?
STRATTERA*▼(ATOMOXETINE) ABBREVIATED PRESCRIBING INFORMATION Presentation Hard capsules: 10mg, 18mg, 25mg, QT or a family history of QT prolongation. Discontinue in patients with jaundice or laboratory evidence of liver injury, and do not restart. on the cardiovascular system can be potentiated. There is the potential for an increased risk of QT interval prolongation when be considered potentially related to atomoxetine. No serious safety concerns were observed during acute or long-
40mg, or 60mg atomoxetine. Uses Treatment of Attention-Deficit/Hyperactivity Disorder (ADHD) in children 6 years of age and older, Use with caution in patients with hypertension, tachycardia, or other cardiovascular disease. Pulse and blood pressure should be atomoxetine is administered with other QT prolonging drugs, (such as neuroleptics, class IA and III anti-arrhythmics, moxifloxacin, term treatment. The following data is from clinical trials in adults: Very common (≥10%): Appetite decreased, insomnia, dry
and in adolescents, as part of a comprehensive treatment programme. Treatment must be initiated by a specialist in the treatment of measured periodically while on therapy. Growth and development should be monitored during treatment with atomoxetine. erythromycin, methadone, mefloquine, tricyclic antidepressants, lithium, or cisapride) drugs that cause electrolyte imbalance (such as mouth, nausea. Common (≥1-<10%): Early morning awakening, libido decreased, sleep disorder, dizziness, middle insomnia,
ADHD. In adolescents whose symptoms persist into adulthood and who have shown clear benefit from treatment, it may be appropriate Consideration should be given to dose reduction or interrupting therapy in patients who are not growing or gaining weight satisfactorily. thiazide diuretics), and drugs that inhibit CYP2D6. Caution is advised with concomitant use of medicinal drugs which are known to lower sinus headache, palpitations, tachycardia, hot flushes, abdominal pain, constipation, dyspepsia, flatulence, dermatitis, sweating
to continue treatment into adulthood. When continuing atomoxetine beyond 1 year, re-evaluation of the need for therapy is Patients requiring long-term therapy should be carefully monitored. Suicide-related behaviour (suicide attempts and suicidal ideation) the seizure threshold (such as antidepressants, neuroleptics, mefloquine, bupropion, or tramadol). Atomoxetine should be used increase, difficulty in micturition, urinary hesitation, urinary retention, dysmenorrhoea, ejaculation disorder, ejaculation failure, erectile
recommended. Initiation in adults is not appropriate. Dosage and Administration For oral use, administered as a single daily dose in has been reported in patients treated with atomoxetine. In double-blind clinical trials, suicide-related behaviours occurred at a frequency cautiously with pressor agents and drugs that affect noradrenaline. Atomoxetine did not cause clinically significant inhibition or induction disturbance, impotence, menstruation irregular, orgasm abnormal, prostatitis, fatigue, lethargy, rigors, weight decreased. Uncommon
the morning, with or without food. Some patients may benefit from taking it twice daily in divided doses. May be taken with or without of 0.44% in atomoxetine-treated patients, with no events in the placebo group. Hostility and emotional lability were more frequently of cytochrome P450 enzymes. Pregnancy and Lactation Should not be used during pregnancy unless the potential benefit justifies the (≥0.1-<1%): Peripheral coldness. Undesirable Effects (Post-Marketing Surveillance) Seizure, QT interval prolongation, Raynaud’s
food and can be discontinued without dose tapering. Dosing of children/adolescents up to 70 kg body weight: Initiate at a total daily dose observed in clinical trials among children and adolescents treated with atomoxetine compared to those treated with placebo. Patients potential risk to the foetus. Due to lack of data, atomoxetine should be avoided during breast-feeding. Driving, etc Use caution when phenomenon, abnormal liver function tests, jaundice, hepatitis, suicide-related events, aggression, hostility, emotional lability, priapism.
of approximately 0.5mg/kg and maintain for a minimum of 7 days prior to upward dose titration according to clinical response and who are being treated for ADHD should be carefully monitored for the appearance or worsening of suicide-related behaviour, hostility, driving or operating hazardous machinery. Undesirable Effects (Clinical Trial Reporting) Children and Adolescents Mild to moderate For full details of these and other side-effects, please see the Summary of Product Characteristics, which is available at
tolerability. The recommended maintenance dose is approximately 1.2mg/kg/day. The safety of single doses over 1.8mg/kg/day and and emotional lability. Introduce with caution in patients with a history of seizure. Discontinuation of atomoxetine should be considered gastro-intestinal disturbance (abdominal pain, decreased appetite, nausea) and sedation are the most common adverse events but http://emc.medicines.org.uk/. Legal Category POM Marketing Authorisation Numbers 00006/0375, 00006/0376, 00006/0377,
total daily doses above 1.8mg/kg have not been systematically evaluated. Dosing of children/adolescents over 70 kg body weight: in any patient developing a seizure or if there is an increase in seizure frequency where no other cause is identified. As with other seldom lead to drug discontinuation as the effects are usually transient and tolerable. Some patients lose weight early in therapy. With 00006/0378, 00006/0379 Basic NHS Cost £15.02 per pack of 7 (10mg, 18mg, 25mg, 40mg), £60.06 per pack of 28 (10mg, 18mg,
Initiate at a total daily dose of 40mg and maintain for a minimum of 7 days prior to upward dose titration according to clinical response psychotropic medications, the possibility of rare, serious psychiatric adverse events cannot be excluded. Interactions Should not be continued treatment, differences in growth (height and weight) are clinically insignificant. In adult and paediatric clinical trials, patients 25mg, 40mg, 60mg). Date of Preparation or Last Review January 2007 Full Prescribing Information is Available From Eli Lilly and
and tolerability. The recommended maintenance dose is 80mg. The maximum recommended total daily dose in children and used in combination with monoamine oxidase inhibitors (MAOIs) and should not be used within 2 weeks of discontinuing therapy with experienced mild increases in heart rate and blood pressure. The following is based on data from clinical trials in child and adolescent Company Limited Lilly House, Priestley Road Basingstoke, Hampshire, RG24 9NL Telephone: Basingstoke (01256) 315 999
adolescents over 70 kg and adults is 100mg. For patients with a known poor metaboliser genotype (CYP2D6 poor metabolisers), a lower a MAOI. Treatment with a MAOI should not be initiated within 2 weeks of discontinuing atomoxetine. Dose adjustment and slower patients: Very common (≥10%): Appetite decreased, abdominal pain, vomiting. Common (≥1-<10%): Influenza, anorexia (loss of *STRATTERA (atomoxetine) is a trademark of Eli Lilly and Company.
starting dose and slower up titration of the dose may be considered. Special Populations Doses may need to be modified in patients titration of atomoxetine may be necessary in those patients who are also taking CYP2D6 inhibitor drugs (eg, SSRIs, quinidine, appetite), early morning awakening, irritability, mood swings, dizziness, somnolence, mydriasis, constipation, dyspepsia, nausea,
with hepatic insufficiency or renal disease. Atomoxetine should not be used in children under 6 years of age. Contra-indications terbinafine). Caution is advised when combining atomoxetine with potent inhibitors of cytochrome P450 enzymes other than CYP2D6 dermatitis, pruritus, rash, fatigue, weight decreased. Uncommon (≥0.1-<1%): Suicide-related events, aggression, hostility, emotional Information about adverse event reporting can be found at www.yellowcard.gov.uk
Hypersensitivity to atomoxetine or any of the excipients. Should not be used in patients with narrow angle glaucoma. Warnings and in patients who are poor CYP2D6 metabolisers. Atomoxetine should be administered with caution to patients being treated with high lability, palpitations, sinus tachycardia. In trials lasting up to ten weeks, weight loss was more pronounced in poor metabolisers. Adults Adverse events should also be reported to Eli Lilly and Company Limited (Tel. no. 0870 240 1125)
Special Precautions Uncommonly, allergic reactions have been reported. Use with caution in patients with congenital or acquired long dose nebulised or systemically administered (oral or intravenous) salbutamol (or other beta2 agonists) because the action of salbutamol Adverse events reported most frequently were gastro-intestinal or genitourinary. Urinary retention or urinary hesitancy in adults should

12. The changing face of
The changing face of
ADHD in young people –
ADHD in young people –
are their emerging
are their emerging
needs being met?
needs being met?
Prescribing information can be found on the back cover

13. Primary to Secondary Functional
Primary to Secondary Academic
The changing nature
The changing nature
Psychosocial
performance,
school
School a life-changing transition social skills,
disruptive/
inappropriate Parent / sibling
of ADHD
of ADHD ng people
relationships,
behaviour
difficulty forming / in you
keeping friendships
* This transition is a key time for personal and social development1
* Hyperactive symptoms become less * Instead, psychosocial issues have a
* Young people will experience:1
• changes in emotional development
of a problem
…the actual symptoms of the original
significant impact
‘…ADHD symptoms may decrease with
• changes in personal identity
• changes in cognitive capacity
The added hyperactive syndrome are less problematic
relative to other psychosocial outcomes in
advancing age (and/or pubertal onset), but
fewer symptoms may be associated with greater
adolescence i.e. low self-esteem, poor school
• puberty problems facing performance and poor peer relationships8
degrees of impairment than was the case in
childhood’
as well as growing independence and responsibility
young people Willoughby M, 200310
‘Failure to establish appropriate behaviour, learning styles and friendships
with ADHD3-9
in the first year of secondary school may have potentially serious
consequences for children’s broader psychosocial development’
Thompson A, 20032
These changing
symptoms cause a new
Self-esteem set of problems for young
Emotio people with ADHD
The transition to secondary school places new
Self-belief,
perception
of
nal
interaction Self-regulat
pressures on young people with ADHD – an ideal with ing
emotional state
others s,
time to re-evaluate patients and their treatment inability to expr
ess
their true
personality

14. Preparation of Vidaza

15. Cover 1 Cover 2 Back Cover 2 Back Cover 1
Prescribe Epipen twin pack for Prescribe Epipen twin pack for
your at risk patients your at risk patients
Epipen Twin Pack contains 0.3mg adrenaline for adults and Epipen Twin Pack contains 0.3mg adrenaline for adults and
children over 30kg in weight children over 30kg in weight
Epipen Junior Twin Pack contains 0.15mg adrenaline for Epipen Junior Twin Pack contains 0.15mg adrenaline for
You need the children up to 30kg in weight children up to 30kg in weight
Often just one
EpiPen®Auto-Injector abbreviated prescribing information. Please EpiPen®Auto-Injector abbreviated prescribing information. Please
refer to the Summary of Product Characteristics before prescribing. refer to the Summary of Product Characteristics before prescribing.
Presentation: EpiPen delivers a single dose of 0.3mg of adrenaline BP Presentation: EpiPen delivers a single dose of 0.3mg of adrenaline BP
other half to
1:1000 (0.3ml)in a sterile solution. EpiPen Jr. delivers a single dose of children 1:1000 (0.3ml)in a sterile solution. EpiPen Jr. delivers a single dose of children
0.15mg adrenaline BP 1:2000 (0.3ml) in a sterile solution. 1.7ml of 15-30kg body weight and 0.3mg 0.15mg adrenaline BP 1:2000 (0.3ml) in a sterile solution. 1.7ml of 15-30kg body weight and 0.3mg
adrenaline remains in the auto-injector after activation. Uses: (EpiPen) adrenaline for children >30kg body weight, or at the adrenaline remains in the auto-injector after activation. Uses: (EpiPen) adrenaline for children >30kg body weight, or at the
Adrenaline is considered the first-line drug of choice for allergic discretionof the physician. EpiPen should only be injected into the Adrenaline is considered the first-line drug of choice for allergic discretionof the physician. EpiPen should only be injected into the
is only half emergencies. Adrenaline effectively reverses the symptoms of rhinitis, anterolateral aspect of the thigh. Contra-indications: There are no emergencies. Adrenaline effectively reverses the symptoms of rhinitis, anterolateral aspect of the thigh. Contra-indications: There are no
urticaria, bronchospasm and hypotension. The strong vasoconstrictor absolute contra-indications to the use of adrenaline in alife threatening urticaria, bronchospasm and hypotension. The strong vasoconstrictor absolute contra-indications to the use of adrenaline in alife threatening
action of adrenaline, through its effect on alpha adrenergic receptors, situation. Warnings: Avoid the risk of inadvertent intravascular action of adrenaline, through its effect on alpha adrenergic receptors, situation. Warnings: Avoid the risk of inadvertent intravascular
solve the acts quickly to counter vasodilation and increased vascular injection. DO NOT INJECT INTO THE BUTTOCKS. Accidental injection acts quickly to counter vasodilation and increased vascular injection. DO NOT INJECT INTO THE BUTTOCKS. Accidental injection
permeability which can lead to loss ofintravascular fluid volume and into the hands or feet may result in loss of blood flow to the affected permeability which can lead to loss ofintravascular fluid volume and into the hands or feet may result in loss of blood flow to the affected
hypotension during anaphylactic reactions. Adrenaline, through its areas. Precautions: Patients must be instructed in the proper use of hypotension during anaphylactic reactions. Adrenaline, through its areas. Precautions: Patients must be instructed in the proper use of
action on beta receptors on bronchial smooth muscles, causes EpiPen. Use with extreme caution in patients with heart disease and action on beta receptors on bronchial smooth muscles, causes EpiPen. Use with extreme caution in patients with heart disease and
the story relaxation which alleviates wheezing and dyspnoea. Adrenaline also those taking digitalis, mercurial diuretic or quinidine. The effects of relaxation which alleviates wheezing and dyspnoea. Adrenaline also those taking digitalis, mercurial diuretic or quinidine. The effects of
alleviates pruritus,urticaria and angioedema and may be effective in adrenaline may be potentiated by tricyclic antidepressants alleviates pruritus,urticaria and angioedema and may be effective in adrenaline may be potentiated by tricyclic antidepressants
relieving gastrointestinal and genitourinary symptoms associated with andmonoamine oxidase inhibitors. Adverse events: May include relieving gastrointestinal and genitourinary symptoms associated with andmonoamine oxidase inhibitors. Adverse events: May include
problem anaphylaxis. Indication: EpiPen is intended for immediate self palpitations, tachycardia, sweating, nausea and vomiting, respiratory anaphylaxis. Indication: EpiPen is intended for immediate self palpitations, tachycardia, sweating, nausea and vomiting, respiratory
administration in the emergency treatment of allergic anaphylactic difficultly, pallor, dizziness, nervousness and anxiety. Legal Category: administration in the emergency treatment of allergic anaphylactic difficultly, pallor, dizziness, nervousness and anxiety. Legal Category:
reactions. Anaphylaxis may be caused by insect stings or bites, foods, POM. Basic NHS Cost: EpiPen and EpiPen Jr. are available as single reactions. Anaphylaxis may be caused by insect stings or bites, foods, POM. Basic NHS Cost: EpiPen and EpiPen Jr. are available as single
drugs and other allergens as well asidiopathic or exercise-induced unit doses at £28.05 each. EpiPen andEpiPen Jr. are also available as drugs and other allergens as well asidiopathic or exercise-induced unit doses at £28.05 each. EpiPen andEpiPen Jr. are also available as
anaphylaxis. Reactions may occur within minutes of exposure and twin packs; two single unitdoses at £56.10. Marketing Authorisation anaphylaxis. Reactions may occur within minutes of exposure and twin packs; two single unitdoses at £56.10. Marketing Authorisation
consist of flushing, syncope, tachycardia, faint or unobtainable pulse Numbers: EpiPen Auto-Injector 10085/0012. EpiPen Jr. Auto- consist of flushing, syncope, tachycardia, faint or unobtainable pulse Numbers: EpiPen Auto-Injector 10085/0012. EpiPen Jr. Auto-
associated with a fall in blood pressure, convulsions, vomiting, Injector10085/0013. Marketing Authorisation holder: ALK-AbellóA/S, associated with a fall in blood pressure, convulsions, vomiting, Injector10085/0013. Marketing Authorisation holder: ALK-AbellóA/S,
diarrhoea and abdominal cramps, involuntary voiding, wheezing, Bøge Alle 6-8, DK-2970, Hørsholm, Denmark. Telephone:+45 4574 diarrhoea and abdominal cramps, involuntary voiding, wheezing, Bøge Alle 6-8, DK-2970, Hørsholm, Denmark. Telephone:+45 4574
dyspnoea due to laryngeal spasm, pruritus, rashes, urticaria 7445 Date of last revision: August 2005. Customer contact: ALK- dyspnoea due to laryngeal spasm, pruritus, rashes, urticaria 7445 Date of last revision: August 2005. Customer contact: ALK-
orangioedema. Dosage and Administration: ADULTS: Self Abelló Ltd, 1 Tealgate, Hungerford, Berkshire,RG17 0YT, United orangioedema. Dosage and Administration: ADULTS: Self Abelló Ltd, 1 Tealgate, Hungerford, Berkshire,RG17 0YT, United
administration of 0.3mg adrenaline (EpiPen) intramuscularly. Kingdom. Telephone: 01488 686016. Website: www.epipen.co.uk or administration of 0.3mg adrenaline (EpiPen) intramuscularly. Kingdom. Telephone: 01488 686016. Website: www.epipen.co.uk or
CHILDREN: The appropriate dosage may be 0.15mg (EpiPen Jr.)for www.alk-abello.co.uk CHILDREN: The appropriate dosage may be 0.15mg (EpiPen Jr.)for www.alk-abello.co.uk
References 2. Stark BJ, Sullivan TJ. Biphasic and protracted anaphylaxis.
Information about adverse event reporting can be found at www.yellowcard.gov.uk 1. Korenblat P, Lundic MJ, Danker RE et al. A retrospective study of J Allergy Clin Immunol 1986; 78(1 Pt 1): 76-83.
epinephrine administration for anaphylaxis: how many doses are 3. Lieberman P. Ann Allergy Asthma Immunol 2005; 95: 217-226.
Adverse events should also be reported to ALK-Abelló Ltd. (tel: 01488 686016) needed? Allergy Asthma Proc 1999; 20(6): 383-6. 4. Lee JM. Pediatrics 2000; 106: 762-766..
Information about adverse event reporting can be found at www.yellowcard.gov.uk
Adverse events should also be reported to ALK-Abelló Ltd. (tel: 01488 686016)
Prescribing information can be found on the back cover Prescribing information can be found on the back cover ALK ABELLO EpiPen ® TWIN ALK ABELLO EpiPen ® TWIN
PACK PACK
Curing Allergy Adrenaline (Epinephrine) Auto-Injector Curing Allergy Adrenaline (Epinephrine) Auto-Injector

16. Inside spread 1 Inside spread 2
Hospital:
Ambulance despatched
One of your patients Pam was one of
has just had an her doctor’s
anaphylactic reaction. Delay: Delivery van
blocking road at risk patients
Has she got everything that So she had everything
she needs? she needed
Pam is allergic to nuts. She also has asthma. She’s ● Patients with:
had reactions before but not as bad as this. She can
feel her throat tightening and is having difficulty breathing.
The answer was simple - a previous history of food induced symptoms
Delay: Road closed - even mild food symptoms but concurrent asthma are
Still, she knows what to do and she’s already given herself an
adrenaline injection and phoned for an ambulance.
find alternative route
- Epipen Twin Pack particularly at risk
- non-food allergies
But now fifteen minutes have passed and she’s not feeling any better.
The ambulance hasn’t arrived and she’s starting to feel panicky. - a history of anaphylactic reactions
What Pam doesn’t know is that: She just needs some Delay: Heavy rush
need Epipen Twin Pack. Carrying two auto-injectors can improve
outcomes.
hour traffic
● 35% of anaphylactic reactions require more than one dose to reverse
symptoms1
● the incidence of biphasic reactions may vary from 1% to as many as
more time. But how? Patient has been waiting
15 minutes because of
By the time the ambulance arrived, Pam had used her second
Epipen and her symptoms had subsided. It had given her the extra
delayed ambulance time that each at risk patient may need one day.
20% of episodes2-4
● the ambulance is stuck in traffic