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Declarations Ethical approval All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions

Online education modules can provide scalable approaches to reaching large numbers of providers efficiently (Morotti et al., 2017)

Most patients with mildly elevated B12 and no identified pathology require only periodic monitoring with reassurance once serious causes have been excluded

Requirements of vitamin B12 in excess of normal (due to pregnancy, thyrotoxicosis, hemolytic anemia, hemorrhage, malignancy, hepatic and renal disease) can usually be met with intranasal or oral supplementation

However, some individualswhether due to conditions like pernicious anemia, gastrointestinal disorders, or the effects of certain surgeriesmay have trouble absorbing enough B12 from food or oral supplements