B1245 pink 7
PinK Conference 2007
Cranage Hall Conference Centre,
Holmes Chapel, Cheshire
Registration will be at 12noonon Friday 2 February and theconference will close at
Prescribing – The Benefits as 12.30pm on Saturday 3
a Specialist Parkinson's Nurse
All delegates will be offered asingle room and there will beno surcharges for
BARBARA STUTTLE CBE is Chair of The Association for Nurse Prescribing and
Director of Primary Care & Modernisation for Thurrock PCT. From February
Theme for next year's
1999 until July 2002 she was on secondment to the Department of Health as a
conference is ‘New
Project Manager in Nurse Prescribing and was instrumental in the
Developments andAutonomic Problems in PD',
implementation of the National Rollout of Nurse Prescribing throughout the
focusing on the multi-
London and South Eastern Regions.
disciplinary team andadvances in future
Parkinson's disease for me is one of those conditions you never forget. Patients and
families, who live with the condition every day, have their lives changed in so many ways.
Specialist nurses in the field play a significant part in affecting people's lives, enabling them
For further information visit
to live as high a quality of life as possible.
Prescribing powers, I believe, enables these specialist nurses to provide a quality service
A cheque for £25 will be
which enables the patient to live an optimum quality of life.
required to support yourplace which is non-
Patients are generally diagnosed with this condition by a neurologist and/or geriatrician.
refundable and will be used
Although having spoken with a specialist nurse in Parkinson's, she informed me how she can
to fund PinK bursaries in
wait at traffic lights and identify someone predisposing to Parkinson's.
The intricacies of this disease are often above the depth of knowledge a GP
would have, because they are generalists. Therefore they will treat symptoms andin my experience, are welcoming to any offers of help and support from specialist nurses.
Supplementary prescribing enables a clinical management plan to be drawn up with the
independent prescriber. This may well involve the hospital consultant, GP as well asspecialist nurse (supplementary prescriber) and the patient.
This to me, is no more or less a care plan so all parties would know exactly what
everyone is doing and what is expected of the progressions of the disease for theindividual patient.
For the supplementary prescriber, this enables them to tailor-make changes to
medications in the laid down boundary, whether medicines or dosages, as the patient'scondition alters. For the patient, it means medications can be adjusted as their conditionchanges to ensure medicines are given appropriately.
Unfortunately, clinical medicines plans in my view have been given a bad press after
being seen as a bureaucratic process. All they are is a communication aid. Surely clear
As referred to in
directions are not difficult if it ensures clear messages are given?
the last issue of
In view of the future direction of the health service, I consider Specialist Parkinson's
PINK, the NICE
nurses need to be independent prescribers so they can deliver appropriate treatment at
guidelines for PD
the right time to maintain the patient's optimum quality of life.
are now published
As all nurses work to their competency and now we have access to the whole BNF, it is
and can be found
imperative all prescribing nurses work to their competency, that as soon as the patients
condition changes, they will refer back to either the GP or neurologist.
continued over the page
Prescribing Information can be found on page 6
Sponsored by Orion Pharma
continued from front page
Often relationships with the patient and specialist nurse are extremely good - making them the first point of contact from the
patient should any changes occur in the condition.
It would be hoped that the nurse would be able to respond swiftly to the patient, therefore ensuring the patient has speedier
access to medicines.
There remains a major difficulty in relation to funding - how do specialist nurses access prescribing budgets? As we move more
into commissioning and provision it is essential that all nurses, and in particular specialist nurses, produce robust service plans asto the benefits of their service.
This needs to include the impact of saving medical time and the unnecessary admission to hospital for some of the patients. By
being able to prescribe, this enhances the above and I am sure there are more benefits that would be part of the service plan.
Many nurses who I meet who are now prescribers, cannot believe the difference it has made to their practice, how much it has
improved care to their patients and credibility with medical colleagues.
I consider Specialist Parkinson's Nurses need to undertake the prescribing training to enhance the service they give to their
patients so you are able to give a comprehensive service.
Getting The Medication Right … And on Time
Anne Martin, a PDNS for Bromley NHS Trust, describes a new system she has introduced which aims
to introduce greater control to the way medication for Parkinson's disease is delivered in nursing and
In Bromley I support about 60 nursing and
recent occasions here in Bromley, two
Professionals often kick against change
residential care homes for respite care and
clients were discharged to homes late at
but the Parkinson's Disease Society's ‘Get
night and arrived with one dose of
it on time' week highlighted where the
Sinemet written on the discharge letter
problem with medications lies - and to me
Often these patients are
and with a different dose on the boxes.
this is one way of moving on.
seen at the homes to preventthem having to travel to clinic
With the availability of the new PD
If you would like a copy of Anne Martin's
in hospital without a carer
medication card, the hope is that on
PD Medication Card contact your local
present, with no idea what
admission, the medications the client is
Orion sales specialist.
medications they are on, or,
taking are recorded accurately on their
even with a carer present
cards and then taken ‘in' with them. Then,
Unable to attend?
who has no idea about the
any changes made while in hospital, are
recorded and signed for on the card by
Please let us know
the discharging doctor and this goes back
If the client used a
to the nursing home with the client.
Please remember, if you are down to
medication card that was
Consequently, any drugs dispensed can
attend the next PINK conference but for
carried with them at all times,
be checked against what is recorded on
some reason are unable to do so, please
especially on respite care,
give us as much notice as possible.
their medications would be
Although we ask delegates to pay a
recorded accurately and then
It also enables autonomy for the client
£25 charge to cover their attendance
written up by the GP
as it gives them some control over their
and hotel, the actual cost to PINK is
on the medications
medications and also reduces the risk of
charts without delay.
clients saying ‘a little yellow tablet' or
In fact we have worked out that if we
‘blue tablet' when they fail to bring their
At present, clients frequently receive
add up travel, hotel, general preparation
medications into clinics or into the
medication labelled ‘take as directed';
and speaker honorarium costs, the total
homes, or fail to carry a repeat
this seems to be a particular problem
cost for the 90 delegates works out at
prescription with them.
with Sinemet and means that records
cannot be written up. This often results in
Another example would be when nursing
These costs are covered through an
a delay in medications being given. As a
or residential homes send the client into
education grant to the PINK group
direct consequence, this can lead to
casualty without a list of medications. It is
from Orion Pharma and other
hospital admission when medications
hoped people could get used to the idea
have been stopped.
of a Parkinson's medication book, like the
The actual cost for each delegate is
anti-coagulant book, this would be sent in
The other problem that medication cards
£138. If a place is therefore not used up,
with the client - we hope.
could help to prevent is the poor
these are costs which PINK still has to
fund – and is obviously money we could
discharges we often experience when
By introducing this system it has got to
put to an alternative use.
patients leave hospital and enter either
be better than the one we have at the
residential or nursing home care.
moment, where we have no way of
If you sign up for next year's conference
recording medications. The risk of giving
but then discover you cannot attend,
Written up wrongly
wrong medications, wrong dosages,
please give us as much notice as
In this day of managing beds rather than
delays in giving medications and not really
possible. Last year we had to turn down
patients' discharges, this can be any time
knowing what they are on would be
applications so with sufficient warning it
of day or night and as a result medications
is likely we will be able to fill in any
greatly reduced by this system.
are often written up wrongly. On two
PINK Research Project –
an update from Dr Carol Haigh
Compliance and concordance in people
with Parkinson's Disease and their carers
Any experienced researcher will tell you that one of the
momentum. The focus
main difficulties about research is that, like packing to go on
group leaders have
holiday, it always takes longer than you think.
had time to read theirway through the very
This has been true of the PINK/University of Salford
useful text book on
collaborative project on compliance and concordance in
people with Parkinson's Disease and their carers.
management that they
Although many people expect ethical review and approval
have been supplied
to be the main cause for delay in research, I am pleased to
with and are raring to go.
report that our application to the Multi-site Research Ethics
So, throughout the summer the focus groups will be held
Committee (MREC) was approved with only minor
up and down the country. The literature review people have
been busy sending their reviews to be moulded into one
Part of the reason for this was the invaluable in-put that
comprehensive review of compliance and concordance in
we had from the members of PINK which allowed for any
people with Parkinson's disease and their carers which
queries to be addressed - simply by highlighting the
should form the first potential publication for this project.
expertise of the clinicians involved.
By the end of the summer we hope to be able to start
looking at the data to begin analysis with a view to havingthe final report written by February/March next year.
The main reason for the post MREC approval delay has
simply been the practicalities of meeting the Research
It must be recorded that the enthusiasm and
Governance Requirements of six different NHS Trusts at
commitment of all of the team involved in this research has
various locations around the country. Certainly the
remained high and the opportunities for learning have
experience of co-ordinating a number of participants over
diverse areas of the UK has been an interesting and
It's not too late to get involved. if you think you would like
to take part in the data analysis please e-mail Dr Carol
However, now the project is progressing well and gaining
Haigh on [email protected]
CONFERENCE 2006 Feedback Report
Overall the feedback from this year's
negative issue commented upon by
within the time constraints but we will
PINK conference was extremely
both delegates and committee
do our best to maintain the standards
members was the lack of space
set in previous years.
available for the display stands – this
From the evaluation forms we
The evening entertainment received
has also been considered in our plans
received, the venue and facilities were
quite mixed reviews. It was
considered more than adequate and
acknowledged that evenings at
most people were able to access the
conferences are the time to network
venue without too much trouble.
and meet with colleagues from all
We were very pleased to see that not
corners of the UK whom we see too
The general consensus seemed to be
one single negative comment was
infrequently. We are certainly
that delegates preferred the previous
made regarding the speakers and their
bearing this in mind as we plan next
arrangement of starting at lunchtime
contributions. They were described on
on Friday and finishing mid-day on
numerous evaluation forms as,
Saturday, a fact the committee has
‘interesting', ‘informative and thought
We would like to say thank you to all
taken on board.
provoking'. Three cheers for the
who completed evaluation forms. Your
comments and feedback will help us
Obviously there was something of a
and future committees to create
hitch with the sound system but this
We also received lots of inspiring
agendas for conferences which meet
was unfortunately beyond our control
suggestions for topics to be covered in
your requirements and needs.
and we want to thank everyone for
the future. Unfortunately we could
bearing with us. The only other
never hope to meet everyone's needs
CONSIDERING A MASTER CLASS COURSE?
MICK CASEY, a Parkinson's disease nurse specialist in Doncaster for four years, describes his recent
experience of a Master Class course.
The Master Class course is aimed at
period of further intensive study,
interest in Parkinson's disease. This
consultants, staff grades and
before starting my masters degree.
raised questions on what medications
specialist registrars in their final year
Having several nursing registrations
were available in order to offer
of training. This is an intensive
and a degree in nursing gave me the
choices to patients. Some areas in
course in which the candidates learn
confidence to undertake the required
my region have restrictions on certain
about the management of Parkinson's
medicines under locally agreed
disease at an advanced level. It is
formularies. This obviously influences
The master class I attended was
held over two three day modules,
treatment choices depending on
run on a very organised schedule of
the first in Newquay and the second
learning. Formal lectures were held
each day as well as interactive
I believe it is at the discretion of the
workshops. Questions and answer
A great deal of networking took
faculty whether places for PDNSs are
sessions were held throughout
place on the course. This was most
made available. I feel that acting in a
valuable as the skills across the whole
consultant nurse role in my post as
Every candidate had to complete a
group ranged from people with a vast
lead PDNS in Doncaster, probably
project during the period between the
amount of knowledge to those who
increased my chances of securing a
two modules of study. These projects
had just started caring for people with
place. All applicants are required to
were individually presented during
submit their reasons for wanting to
sessions set aside in the second
attend the course. I submitted
I enjoyed the course immensely and
module. Each stage of the course
several letters via email and the
would recommend it to all who are
was audited and evaluated. Mentors
obligatory 250-word statement.
able to access it. It would seem a
were assigned to each candidate so
logical step for PDNSs to set up their
that supervision was accessible
own master class course accredited
throughout the whole duration of
As a healthcare professional, I have
by the appropriate body.
always strived to improve my
Mick TP Casey, BA Hons, Dip N,
knowledge and skills. As a PDNS,
The project I chose was a regional
RNMH, RN, SPDN, CHCN, PDNS.
the master class was the ideal
survey of prescribing choices
(Graduate of the Master Class).
opportunity for me to undertake a
amongst prescribers with a special
2. What do you enjoy most about
6. What is the worst job you
Jerry Playfer your job?
have ever had?
Working in a team and gossip!
Barman! - I lasted one day!
1. Who most influenced your
3. What is your most
7. What is guaranteed to make
Carole Gardner, was the first ward
sister I worked with as a HouseOfficer. Unlike today, we entered the
Only recently, I went out on a
Talking to PD nurses!
wards very unprepared as far as
domiciliary visit to a Chinese patient.
practical procedures and time
The interpreter was delayed, so I spent
half an hour taking a pigeon Englishhistory and painstaking examination of
Carole taught me how to put up a
an elderly Chinese man. When the
drip, how to pass a catheter and was
translator arrived, she said the Chinese
tremendously supportive in my first
name was female, at which point,
three months as a qualified doctor,
the old gentleman's wife emerged
giving me confidence for my future
from a back room and I had to start
PROFILEcareer. I admired her dedication and the process all over again!
professionalism which has always
Playfer is a
made me a strong champion of
nurses, including marrying one!
4. If you could change one
Secondly, I was attracted to geriatric
thing about your job what
medicine by the example of
would it be?
Professor Jimmy Williamson, who
The job is perfect!
was a superb physician with a real
has a special
knowledge of Parkinson's disease
and a great humanitarian approach to
5. What book, film and piece of
medicine. He encouraged and
disease. He is
music would you take to a
supported my development as a
geriatrician when I started my
President of the
research in Liverpool.
Book - The Great Gatsby, Film -
Notting Hill - Music - Coldplay CD
Primary Care – We Need
to Look at Different Routes
for Service Provision
GREG ROGERS, a GP in East Kent, describes a model of care
delivery he has helped develop for epilepsy patients – and believes it
could work equally well for treating PD patients within primary care. Specialist nurses
would be fundamental to its success.
Do you often feel dragged into yet another
which will soon run in the five PCTs of East Kent.
change which means financial cuts and more
To qualify for this, a lead GP is nominated and has basic
training in epilepsy management and oversees the straight
forward care of people with epilepsy in their surgery. If
Allied to this is
less straightforward needs come to light, the GPwSIs in
the real threat of redundancy.
epilepsy are approached for help and advice.
I must say if the media reported
This system of GPwSIs and the Epilepsy LES facilitates
me as a ‘soft target,' for
the prompt discharge from out-patient clinics of people
redundancy, I would not only feel very
who have some modification of their treatment left to do.
threatened, but also very under-valued
The consultants can be confident to discharge these
for my professional work.
patients, in the knowledge that they will not ‘slip through
Could the way forward be to
the net' following discharge, knowing if problems occur,
lead with these changes rather
they will be re-referred back to secondary care.
The scheme aims to provide a seamless care for this
population and also free up out-patient clinics to be
specialist interest in
responsive for those with acute or complex needs.
epilepsy [GPwSI in
Surely this could also be extended for the treatment of
this coming largely from a desire to work for the hidden
How do the specialist nurses fit in with this? To create
population who continue to suffer from epilepsy but who
seamless care the interface close to secondary care for
seem to have only a weak voice in society and indeed in
refractory or complex care relies largely with the
The routine needs of people with epilepsy could be
With a caseload of more complex cases which
greatly improved by primary care – however since the late
necessities the ear of the secondary care specialist, the
1980s the routine care of people with epilepsy has largely
specialist nurses are fulfilling a role that a GPwSI could
been placed in secondary care, which means primary care
not meet. This role requires frequent discussions and
has lost many of the skills it once had in this area.
could only be fulfilled by a health professional whose solejob is Epilepsy [or PD] and who is mobile.
Restricted access to epileptologists is a national problem
and primary care surely needs to regain the place as
Also the answering of patient queries by phone five days
provider of routine care.
a week and education on the wards and within institutionsis surely best managed by a nurse specialist.
One solution I have been working on requires education
and the development of a network of GPs specialised in
I would imagine becoming an indispensable part of the
the care of epilepsy [GPwSIs in Epilepsy] that provide
team is the safest way to secure a job - while spreading
oneself too thinly to ‘make a difference' could make thisposition weaker.
By being peripatetic, part of their brief is also to share
these skills with their colleagues in practice. With the
There are as yet only a few GPwSIs in PD and no
support of the East Kent PCTs, I have trained eight GPs to
nationally adopted LES for PD. Surely however it is
become GPwSIs in epilepsy, serving a population of over
essential to look ahead and work with those developing
600,000 and take direct referrals from colleagues.
routes of service provision? They may look very differentto my ideas here but being involved in modelling of such
Following this development, the PCT have developed a
schemes will not only be in the best interests of the
Locally Enhanced Service [LES] for epilepsy which at
people we work with, but in the long run, for ourselves.
present is only being offered in East Kent Coastal PCT but
Stalevo Case Study Stalevo® (levodopa, carbidopa, entacapone),
KAY HOOD, a Parkinson's disease nurse specialist within a busy movement disorder clinic in Stobhill
Hospital, Glasgow reports on a recent experience prescribing Stalevo.
I have four years experience as a PDNS
levodopa bioavailability and more stable
periods of anxiety and she complained
and have day to day contact with clients
concentrations of levodopa in the brain
of general aches and pains.
who have advancing disease, and,
(Olanow, 2001; Schrag, 2005).
It is important to note that the majority
consequently more troublesome disease
We were also keen to observe whether
of these symptoms were alleviated by
symptoms as well as side effects from
patients reported any additional benefits
her next dose of medication.
than those taking levodopa plus a
Following discussion it was agreed to
Therefore it is always encouraging to
commence on Stalevo tablets 100mg
hear of new preparations available to
inhibitor in two separate tablets.
one tablet Q.I.D. The basic
manage their problems.
Administering entacapone separately
pharmacology of the medication was
It was pleasing to hear that Stalevo
without levodopa is ineffective –
discussed and it was agreed that MR
tablets (a combination of levodopa,
prescribing Stalevo would avoid this.
would be reviewed at clinic in six weeks.
carbidopa and entacapone) were licensed
The following is a case study to
On review there were no detectable
for use in November 2003. It is thought
examine the effect of Stalevo therapy.
motor signs, her mood had improved
that Stalevo may provide a less pulsatile
significantly and she reported no
delivery of dopamine, resulting in more
"wearing off" effects or fluctuations in
stable levels of dopamine reaching the
MR is a sixty five year old lady who
her condition. The Stalevo regime was
striatum (Stocchi et al 2003, Rinne et al
was diagnosed with Parkinson's disease
well tolerated with no harmful side
1998). More stable dopamine delivery is
in 1999. Unfortunately she had been
effects and the client was happy to
thought to delay the need to increase the
unable to tolerate any of the dopamine
continue to use it as she felt a major
dose of levodopa/DDCI (Larsen 2003).
agonists due to side effects. After tryingto convince her to commence traditional
benefit. The combination tablet allowed
We were particularly keen to observe
levodopa/DDCI therapy she agreed to do
the regime to be simplified and halved
the effect Stalevo therapy had on
so, due to increasing disability.
the daily dosage that would have been
patients who were not experiencing the
taken if prescribed traditional
same duration of effect from traditional
After initially being prescribed
entacapone and Sinemet tablets. In June
levodopa as they had previously. Stalevo
Levodopa of Sinemet 62.5mg TID,
2006 the client concerned continued to
is an enhanced levodopa formulation
increasing to Sinemet Plus, one tablet
perform well on the above regime.
containing the dopadecarboxylase
QID, the condition of the patient
inhibitor(DDCI), carbidopa and the
remained stable. However, earlier this
catechol-O-methyl transferase (COMT)
year, when she was reviewed at the
Rinne UK et al 1998 Neurology 51 1309-1314
inhibitor, entacapone. The inclusion of a
nurse led movement disorders clinic, she
Stocchi F et al 2003 Neurology Science 24 217-218
DDCI blocks down the breakdown of
reported that her Parkinson's symptoms
Larsen J P et al Eur J Neur 2003;10:137-146
levodopa in the periphery but levodopa
were beginning to return before her next
Olanow CW, Watts RL, Koller WC. An algorithm
is still broken down into 3-O-methyldopa
dose of levodopa was due (wearing off).
(decision tree) for the management of Parkinson's
in the periphery.
Symptoms reported included increased
disease (2001): Treatment Guidelines. Neurology
By also including the catechol-O-
stiffness and tremor and on examining
2001; 56 (Suppl 5):S1-S88.
methyltranferase (COMT) inhibitor,
her gait speed it was markedly slower
Schrag A. Entacapone in the treatment of
entacapone, this route of metabolism is
than previously. On further discussion
Parkinson's disease. Lancet Neurology 2005;
blocked. This leads to an increase in
and examination her mood was low with
Stalevo (levodopa / carbidopa / entacapone) Prescribing Information
Indication: Treatment of patients with
Parkinson's disease and end-of-dose motor fluctuations not stabilised on levodopa/dopa decarboxylase (DDC) inhibitor treatment. Dosage and administration:
Orally with or without food. One tablet contains one treatment dose and may only be administered as whole tablets. Optimum daily dosage must be determined by
careful titration of levodopa in each patient preferably using one of the three tablet strengths. Patients receiving less than 70-100 mg carbidopa a day are more likely
to experience nausea and vomiting. The maximum Stalevo dose is 10 tablets per day. Usually Stalevo is to be used in patients who are currently treated with
corresponding doses of standard release levodopa/DDC inhibitor and entacapone. See SPC for details of how to transfer these patients and those not currently
treated with entacapone. Children and adolescents: Not recommended. Elderly: No dosage adjustment required. Mild to moderate hepatic impairment, severe renal
impairment (including dialysis): Caution advised. Contraindications: Hypersensitivity to active substances or excipients. Severe hepatic impairment. Narrow-angle
glaucoma. Pheochromocytoma. Concomitant use of non-selective monoamine oxidase inhibitors (e.g. phenelzine, tranylcypromine). Concomitant use of a selective
MAO-A inhibitor and a selective MAO-B inhibitor. Previous history of Neuroleptic Malignant Syndrome (NMS) and/or non-traumatic rhabdomyolysis. Warnings and
precautions: Not recommended for treatment of drug-induced extrapyramidal reactions. Administer with caution to: patients with severe cardiovascular or
pulmonary disease, bronchial asthma, renal, hepatic or endocrine disease, or history of peptic ulcer disease or of convulsions, or past or current psychosis; patients
receiving concomitant antipsychotics with dopamine receptor-blocking properties, particularly D2 receptor antagonists; patients receiving other medicinal products
which may cause orthostatic hypotension. In patients with a history of myocardial infarction who have residual atrial nodal, or ventricular arrhythmias, monitor cardiac
function carefully during initial dosage adjustments. Monitor all patients for the development of mental changes, depression with suicidal tendencies, and other
serious antisocial behaviour. Patients with chronic wide-angle glaucoma may be treated with Stalevo with caution, provided the intra-ocular pressure is well
controlled and the patient is monitored carefully. Caution when driving or operating machines. Doses of other antiparkinsonian treatments may need to be adjusted
when Stalevo is substituted for a patient currently not treated with entacapone. Rhabdomyolysis secondary to severe dyskinesias or NMS has been observed rarely
in patients with Parkinson's disease. Therefore, any abrupt dosage reduction or withdrawal of levodopa should be carefully observed, particularly in patients who
are also receiving neuroleptics. Periodic evaluation of hepatic, haematopoietic, cardiovascular and renal function is recommended during extended therapy. Monitor
weight in patients experiencing diarrhoea. Contains sucrose therefore should not be taken by patients with rare hereditary
problems of fructose intolerance, glucose-galactose malabsorption or sucrase-isomaltase insuffiency. Undesirable
effects: Levodopa / carbidopa - Most common: dyskinesias including choreiform, dystonic and other involuntary
Orion Pharma is the sponsor
movements, nausea. Also mental changes, paranoid ideation and psychotic episodes, depression, cognitive dysfunction.
Less frequently: irregular heart rhythm and/or palpitations, orthostatic hypotensive episodes, bradykinetic episodes (the
company of PINK and is one
'on-off' phenomenon), anorexia, vomiting, dizziness, and somnolence. Entacapone - Most frequently relate to increased
of the leading companies in
dopaminergic activity, or to gastrointestinal symptoms. Very common: dyskinesias, nausea and urine discolouration.
Common: insomnia, hallucination, confusion and paroniria, Parkinsonism aggravated, dizziness, dystonia, hyperkinesias,
the healthcare sector in the
diarrhoea, abdominal pain, dry mouth constipation, vomiting, fatigue, increased sweating and falls. See SPC for details of
Nordic area of Europe.
laboratory abnormalities, uncommon and rare events. Legal category: POM. Presentations, basic NHS costs and
marketing authorization numbers: Stalevo 50 mg/12.5 mg/200 mg, 30 tablet bottle £21.72, 100 tablet bottle £72.40, MA
For further information visit
numbers: EU/1/03/260/002-003; Stalevo 100 mg/25 mg/200 mg, 30 tablet bottle £21.72, 100 tablet bottle £72.40, MAnumbers: EU/1/03/260/006-007; Stalevo 150 mg/37.5 mg/200 mg, 30 tablet bottle £21.72, 100 tablet bottle £72.40 MA
numbers: EU/1/03/260/010-011. Distributed by: Orion Pharma (UK) Ltd. Oaklea Court, 22 Park Street, Newbury,
Berkshire, RG14 1EA, UK. Full prescribing information is available on request. Stalevo is a registered trademark. Date of
Prescribing Information: April 2006.
Information about adverse event reporting can be found at www.yellowcard.gov.uk. Adverse events shouldalso be reported to Orion Pharma (UK) Ltd on 01635 520300.
Item date: September 06
Mr. Sanjay Singh MBBS, MS, FRACS, FRCS (UK) 2 - 4 Charles Street Tel: 02 4474 3774 Fax: 02 4474 3775 Write questions or notes here: Surgery for Ingrowing Toenail (adult) Further Information and Feedback:You can get more information about this procedure at aboutmyhealth.orgTell us how useful you found this document at www.patientfeedback.orgBrochure code: GS16
1.0 INTRODUCTION TO THE STUDY Forum Syd, a Swedish Non Governmental Organization (NGO) working together with The Livelihoods Foundation (LEO), a Kenyan NGO to support the Empowerment of Rural Population in Nyatoto Community in Central Division of Homa Bay County in Kenya, Africa. Forum Syd has solicited support from SIDA, Sweden to fulfill this objective. LEO