scholarly journals P145 A review of vitamin D testing in primary care: significant savings to be made

Rheumatology ◽  
2020 ◽  
Vol 59 (Supplement_2) ◽  
Author(s):  
Emily Riding ◽  
Elizabeth MacPhie
Keyword(s):  
Primary Care ◽  
Vitamin D ◽  
High Risk ◽  
British Society ◽  
Repeated Testing ◽  
North West ◽  
The North ◽  
Number Of Patients ◽  
Vitamin D Levels ◽  
Lower Limb Pain

Abstract Background Vitamin D deficiency is common in the UK due to a lack of sunlight over the winter months. Risk factors include darker skin and reduced exposure to sunlight (e.g. housebound/institutionalised patients or those who cover skin for religious reasons). As part of the Choosing Wisely campaign, the British Society for Rheumatology recommend that vitamin D testing should be reserved for people at high risk of deficiency and avoided as part of routine investigation of widespread pain alone. They also recommend that repeat testing isn’t usually necessary in patients who are taking vitamin D supplements. The aim of this project was to review the testing of Vitamin D in a Primary Care setting. Methods An EMIS search was conducted for patients who had their vitamin D levels tested in September and October 2017. The following information was collected for each patient: indication for testing, vitamin D level, whether vitamin D had been tested previously or subsequently, treatment offered and the patient’s residence. Results 96 patients had their vitamin D levels checked. Of these, 8 were excluded as they had been tested on the advice of secondary care. Of the remaining 88 patients, 6 (6%) were vitamin D deficient and 34 (38%) had insufficient vitamin D levels. The most common indication for testing was tiredness in 26 patients (30%) followed by generalised aching/lower limb pain 19 (22%). 8 (9%) patients were tested due to pain at specific sites including a single joint or abdominal pain, 5 (6%) due to neurological symptoms, 4 (5%) due to a diagnosis of CKD and 3 (3%) due to skin and hair problems. There was no clearly documented indication for testing levels in the remaining 3 (3%) patients. 35 (40%) patients had previously had their vitamin D levels tested and 19 (22%) patients had subsequent testing. Of the patients with abnormal vitamin D levels, 22 (25%) were prescribed treatment, 16 (18%) advised to buy over the counter and no advice was documented in 16 (18%) patients. None of the patients lived in residential or nursing homes. Conclusion This project identified a range of indications for vitamin D testing and a large number of patients who had repeated testing. This highlights a potential area for education in primary care surrounding the value in both initial and repeated testing of vitamin D levels. The findings show a need for an improvement in documentation as some patients had no clear linked reason for testing and no evidence that abnormal levels were actioned. However, there were limitations to determining whether BSR guidelines were followed as some factors that would lead to patients being at high risk of deficiency (such as skin colour) could not be collected from EMIS. Disclosures E. Riding None. E. MacPhie Other; EM is the secretary of the North West Rheumatology Club; meetings are supported by an unrestricted educational grant from UCB.

scholarly journals FRI0649-HPR HYDROXYCHLOROQUINE PRESCRIBING AND OPHTHALMOLOGY SCREENING WITHIN RHEUMATOLOGY DEPARTMENTS IN THE NORTH-WEST OF THE UNITED KINGDOM: A PROSPECTIVE REGIONAL AUDIT

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 928.2-929
Author(s):  
S. Juman ◽  
T. David ◽  
L. Gray ◽  
R. Hamad ◽  
S. Horton ◽  
...  
Keyword(s):  
High Risk ◽  
Risk Group ◽  
Service Level ◽  
High Risk Group ◽  
North West ◽  
The North ◽  
The United Kingdom ◽  
The Uk ◽  
Treatment Dosage ◽  
Sd Oct

Background:Hydroxychloroquine (HCQ) is widely used in the management of rheumatoid arthritis and connective tissue disease. The prevalence of retinopathy in patients taking long-term HCQ is approximately 7.5%, increasing to 20-50% after 20 years of therapy. Hydroxychloroquine prescribed at ≤5 mg/kg poses a toxicity risk of <1% up to five years and <2% up to ten years, but increases sharply to almost 20% after 20 years. Risk factors for retinopathy include doses >5mg/kg/day, concomitant tamoxifen or chloroquine use and renal impairment. The UK Royal College of Ophthalmologists (RCOphth) 2018 guidelines for HCQ screening recommend optimal treatment dosage and timing for both baseline and follow-up ophthalmology review for patients on HCQ, with the aim of preventing iatrogenic visual loss. This is similar to recommendations made by the American Academy of Ophthalmology (2016).Objectives:To determine adherence to the RCOphth guidelines for HCQ screening within the Rheumatology departments in the North-West of the UK.Methods:Data for patients established on HCQ and those initiated on HCQ therapy were collected over a 7 week period from 9 Rheumatology departments.Results:473 patients were included of which 56 (12%) were new starters and 417 (88%) were already established on HCQ. 79% of the patients were female, with median ages of 60.5 and 57 years for new and established patients respectively. The median (IQR) weight for new starters was 71 (27.9) kg and for established patients, 74 (24.7) kg.20% of new starters exceeded 5mg/kg daily HCQ dose. 16% were identified as high risk (9% had previously taken chloroquine, 5% had an eGFR <60ml/min/m2and 2% had retinal co-pathology). Of the high-risk group, 44% were taking <5mg/kg. In total, 36% of new starters were referred for a formal baseline Ophthalmology review.In the established patients, 74% were taking ≤5mg/kg/day HCQ dose and 16% were categorized as high risk (10% had an eGFR less than 60ml/min/m2, 3% had previous chloroquine or tamoxifen use and 2% had retinal co-pathology). In the high-risk group, 75% were not referred for spectral domain optical coherence tomography (SD-OCT). 41% of patients established on HCQ for <5 years, and 33% of patients on HCQ for >5 years were not referred for SD-OCT. Reasons for not referring included; awaiting 5 year review, previous screening already performed and optician review advised.Since the introduction of the RCOphth guidelines, 29% patients already established on HCQ had an alteration in the dosage of HCQ in accordance with the guidelines. In the high-risk group, 16% were not on the recommended HCQ dose.Conclusion:This audit demonstrates inconsistencies in adherence to the RCOphth guidelines for HCQ prescribing and ophthalmology screening within Rheumatology departments in the North-West of the UK for both new starters and established patients. Plans to improve this include wider dissemination of the guidelines to Rheumatology departments and strict service level agreements with ophthalmology teams to help optimize HCQ prescribing and screening for retinopathy.Acknowledgments:Drs. S Jones, E MacPhie, A Madan, L Coates & Prof L Teh. Co-1st author, T David.Disclosure of Interests:None declared

scholarly journals Vitamin D Status in Preeclamptic and Non-preeclamptic Pregnant Women: A Case-Con­trol Study in the North West of Iran

2015 ◽  
Vol 5 (3) ◽  
pp. 183-190 ◽  
Author(s):  
Bita Sadin ◽  
Bahram Pourghassem Gargari ◽  
Fatemeh Pourteymour Fard Tabrizi
Keyword(s):  
Vitamin D ◽  
Pregnant Women ◽  
Vitamin D Status ◽  
North West ◽  
The North

The Majority of Myeloma Patients Are Vitamin D Deficient, Unrelated to Survival or Cytogenetics

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 5336-5336 ◽  
Author(s):  
Samantha Hudzik ◽  
Beau Snoad ◽  
Luay Mousa ◽  
Douglas W Sborov ◽  
Nita Williams ◽  
...  
Keyword(s):  
Vitamin D ◽  
Overall Survival ◽  
High Risk ◽  
Bone Disease ◽  
Proportional Hazards ◽  
Conflicts Of Interest ◽  
Cox Proportional Hazards ◽  
Plasma Cell Dyscrasia ◽  
Markers Of Inflammation ◽  
Vitamin D Levels

Abstract Introduction: Since a link between solar radiation, vitamin D production, and decreased colon cancer mortality was established in 1980, there has been increasing interest in vitamin D and cancer, suggesting that higher vitamin D levels improve overall survival, specifically in breast and colorectal cancer (Maalmi H et al, Eur J Canc, May-2014, PMID 24582912), but also in follicular lymphoma (Kelly JL, J Clin Onc, 1-May-2015, PMID 25823738). In myeloma, largest published series is from the Mayo Clinic reporting on 148 newly diagnosed MM patients for which no survival association was found, but there were associations between low 25-OH-Vit D (<20 ng/mL) and higher serum CRP, serum creatinine, and ISS stage (Ng AC, Am J. Heme, Jul-2009, PMID 19415724); we wanted to expand on their trailblazing analysis. Cytogenetically high risk myeloma characterized by the amplification of 1q21 is associated with increased serum levels of soluble IL-6 receptor (sIL-6r) (Stephens OW, Blood, 2012, PMID 22072558) which may be associated with other markers of inflammation, e.g. CRP, creatinine, and b2microglobulin. Methods: The Buckeye Myeloma Registry (OSU 10115) opened in 2011 to enroll any patient with a plasma cell dyscrasia. Serum total 25-OH-Vitamin D was measured at the time of the initial clinic visit to the myeloma group at Ohio State. Results: Of a total of 843 patients, 115 (13.6%), 53 (6.3%) with SMM, and 675 (80.1%) with MM. In the 675 MM patients, the median age was 64 y.o. (range 28-95), 14.5% African-American and the remainder Caucasian, with 28.6% ISS stage 1, 48.7% ISS stage 2, 21.9% ISS stage 3, and 24.5% unknown. At diagnosis for the MM patients, 67% presented with lytic bone disease. Out of 675 MM patients, there were 52 (7.7%) patients with < 10 ng/mL 25-OH-Vit D, 394 (51%) with low vit D (10-30 ng/mL), and 229 (39%) for 25-OH-Vit D 30-100 ng/mL. There was no correlation between 25-OH-Vit D and BMI or creatinine, but there was a strong correlation with race (r=0.18, p<0.000026). Among the MM patients, log-rank [Mantel-Cox] analysis of overall survival with serum 25-OH-Vit D including all groups demonstrated no significant differences (p=0.9725) with only 101 events. There was no correlation between 25-OH-Vit D and the presence on CD138-selected FISH of 1q21 amplification (p=0.196), 17p (p53) deletion (p=0.68), or 13q deletion (p=0.812). Conclusion: The majority of myeloma patients are vitamin D deficient, but this was not associated with worsened overall survival or with high risk cytogenetics. Cox proportional hazards analyses of survival adjusted for significant univariate covariates will be presented at the meeting. Correlations with presence or absence of diffuse lytic bone disease, severity of renal insufficiency, and race will also be presented at the meeting. Disclosures No relevant conflicts of interest to declare.

PALB2 mutations in Brazilian patients from North-Northeast regions.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e13670-e13670
Author(s):  
Thamara Ferreira ◽  
Thais Ferreira Bomfim-Palma ◽  
Isabelle Joyce de Lima Silva-Fernandes ◽  
Gabriela Espirito Santo Felix ◽  
Inacelli Queiroz De Souza Caires ◽  
...  
Keyword(s):  
Breast Cancer ◽  
High Risk ◽  
Male Breast Cancer ◽  
Clinical Management ◽  
Susceptibility Gene ◽  
High Risk Patient ◽  
Male Breast ◽  
The North ◽  
Number Of Patients ◽  
Increased Risk

e13670 Background: Loss-of-function mutations in PALB2 gene are associated with increased risk for breast cancer and possibly pancreatic, ovarian, male breast, prostate, colorectal as others cancers. In Brazil it has been estimated that up to 1,516 new cases of hereditary breast cancer for 2020 in the North and Northeast regions. Analysis of susceptibility gene mutations helps identify precisely the high-risk patient and their families, whom need specific and personalized clinical management as high-risk individuals. Methods: Twenty-six patients with pathogenic mutations in PALB2 gene identify by next-generation sequencing from states of Bahia (11), Ceará (9), Pernambuco (5) and Rondônia (1) in the North and Northeast regions were analyzed. Results: Most of the patients analyzed had only breast cancer (80%), including two cases of male breast cancer (9,5%); the others were isolated cases of endometrial cancer (4%), breast and pancreas cancers (4%), breast and lung cancers (4%), only ovarian cancer (4%) and ovarian and breast cancers (4%). Most cancers were stage II or III (65%). Family history of cancer was observed in 22/26 (84%); the most common tumors were breast, prostate, pancreas and thyroid. The founder mutations were more frequent in exons: 4 (58%) and 12 (15%). Eleven variants were found as follow: c.1240C > T (19%); c.3256delC (15%); c.1671_1674delTATT (11.5%); c.355delC (11.5%); NC_000016.9:g.(?_23632673)_(23652488_?)del (11,5%). The greatest variety of mutations was found in the state of Bahia, probably due to the greater number of patients included (42%). Conclusions: These data suggest that changes in clinical management of PALB2 patients are needed since the phenotype observed exhibited pattern of hereditary tumors, including male breast cancer. Besides that, PALB2 gene should be included in painel gene analysis in patients from the North and Northeast of Brazil because its high frequency of pathogenic variants.

Outcomes Associated with Restored and Unrestored Deciduous Molar Teeth

2002 ◽  
Vol os9 (1) ◽  
pp. 16-19 ◽  
Author(s):  
Keith M Milsom ◽  
Martin Tickle ◽  
David King ◽  
Paula Kearney-Mitchell ◽  
Anthony S Blinkhorn
Keyword(s):  
Dental Treatment ◽  
Working Party ◽  
British Society ◽  
North West ◽  
The North ◽  
Dental Practitioners ◽  
History Of ◽  
Molar Teeth ◽  
Deciduous Molar ◽  
Deciduous Molars

Introduction Most dental treatment for children in the United Kingdom (UK) is provided by general dental practitioners (GDPs) working in the National Health Service (NHS). A working party of the British Society of Paediatric Dentistry, in a special publication from the Dental Practice Board, has suggested that failure to provide restorative care for the deciduous dentition is unacceptable, yet GDPs are filling fewer teeth in young children. The study aimed to evaluate the health outcomes obtained from restoring carious deciduous molar teeth. Method The dental records of 677 children cared for by 50 GDPs in the north west of England were analysed. Results The results showed that 18.8% of deciduous molars with unrestored caries and 17.0% with a history of restorative care went on to be extracted because of pain or sepsis. Conclusion The results suggest that the risk of carious deciduous molars being extracted is similar whether these teeth receive restorative care or not.

Vitamin D levels and trabecular bone remodelling before and after surgery for medullary thyroid carcinoma

1984 ◽  
Vol 106 (3) ◽  
pp. 346-349 ◽  
Author(s):  
K. Emmertsen ◽  
F. Melsen ◽  
L. Mosekilde ◽  
Bi. Lund ◽  
Bj. Lund ◽  
...  
Keyword(s):  
Vitamin D ◽  
Thyroid Carcinoma ◽  
Trabecular Bone ◽  
Medullary Thyroid Carcinoma ◽  
Bone Remodelling ◽  
Vitamin D Metabolism ◽  
Medullary Thyroid ◽  
Number Of Patients ◽  
Vitamin D Levels ◽  
Before And After

Abstract. We previously reported increased mean serum 1,25-dihydroxyvitamin D (1,25-(OH)2D) and increased trabecular bone remodelling in patients with medullary thyroid carcinoma (MCT) and hypercalcitoninaemia. In the present paper we report that serum 1,25-(OH)2D and trabecular bone remodelling decreased following surgical cure for MCT and hypercalcitoninaemia in 4 patients despite no detectable post-surgical hypoparathyroidism or hypothyroidism. The results obtained in the present small number of patients suggest that the altered vitamin D metabolism and trabecular bone remodelling in patients with MCT is caused by the hypercalcitoninaemia.

A STUDY OF VITAMIN D LEVELS AND CIRCULATORY RISK FACTORS IN PRIMARY CARE

2011 ◽  
Vol 29 ◽  
pp. e170
Author(s):  
A. Mastan ◽  
A. Bokhari ◽  
R. Aghamohammadzadeh ◽  
A. M. Heagerty
Keyword(s):  
Risk Factors ◽  
Primary Care ◽  
Vitamin D ◽  
Vitamin D Levels

scholarly journals Modelling Local Patterns of Children Mortality. A Bayesian Spatio-Temporal Analysis.

2019 ◽  
Author(s):  
Alejandro Lome-Hurtado ◽  
Jacques Lartigue Mendoza ◽  
Juan Carlos Trujillo
Keyword(s):  
High Risk ◽  
Mortality Risk ◽  
Temporal Analysis ◽  
Health Concern ◽  
North West ◽  
The North ◽  
Policy Interventions ◽  
Medium Risk ◽  
Spatio Temporal ◽  
Over Time

Abstract Background: The number of death children at the international scale are still high, but with proper spatially-targeted health public policies this number could be reduced. In Mexico, children mortality is a particular health concern due to its alarming rate all throughout North America. The aims of this study are i) to model the change of children mortality risk at the municipality level, (ii) to identify municipalities with high, medium and low risk over time and (iii) to ascertain potential high-risk municipalities across time, using local trends of each municipality in Greater Mexico City. Methods: The study uses Bayesian spatio-temporal analysis to control for space-time patterns of data. This allow to model the geographical variation of the municipalities within the time span studied. Results: The analysis shows that most of the high-risk municipalities are in the north, west, and some in the east; some of such municipalities show an increasing children mortality risk over time. The outcomes highlight some municipalities which show a medium risk currently but are likely to become high risk along the study period. Finally, the odds of children mortality risk illustrate a decreasing tendency over the 7-year framework. Conclusions: Identification of high-risk municipalities may provide a useful input to policy-makers seeking out to reduce the incidence of children mortality, since it would provide evidence to support geographical targeting for policy interventions.

scholarly journals Algorithm for determining the feasibility of referring a patient for consultation with pediatric oncologist: results of implementation

2020 ◽  
Vol 64 (6) ◽  
pp. 84-88
Author(s):  
M. Yu. Rykov ◽  
O. A. Manerova ◽  
I. A. Turabov ◽  
V. V. Kozlov ◽  
V. A. Reshetnikov
Keyword(s):  
Clinical Practice ◽  
Social Study ◽  
Federal District ◽  
Steady Increase ◽  
North Caucasus ◽  
North West ◽  
The North ◽  
Number Of Patients ◽  
Pediatric Oncologist ◽  
Oncological Diseases

Actuality. Over the past decades, there has been a steady increase in the number of oncological diseases in children, most of which are detected at common stages. Moreover, only 5.2% of patients are actively detected (during routine preventive examinations).Material and methods. In order to detect oncological diseases in children in the early stages, an “Algorithm for determining the feasibility of referring a patient for consultation with a pediatric oncologist” (hereinafter referred to as the Algorithm) has been developed, which is a questionnaire of 20 questions. Answering with unambiguous answers (yes / no), a local pediatrician may decide on further tactics of examination and treatment of the patient. In order to analyze the results of the implementation of the Algorithm, a “Questionnaire for a local pediatrician to evaluate the effectiveness of the implementation of the Algorithm for determining the feasibility of referring a patient for a consultation with a pediatric oncologist” has been developed, which consisted of 10 questions.Results. 427 district pediatricians took part in the medical and social study, taking into account stratification by federal districts of the Russian Federation: from the Central Federal District – 101 (23.6%) respondents, from the North-West Federal District – 40 (9.2%), from the Southern Federal District – 47 (10.9%), from the North Caucasus Federal District – 32 (7.7%), from the Volga Federal District – 92 (21.4%), from the Ural Federal District – 32 (7.7%), from the Siberian Federal District – 55 (12.9%) ), from the Far Eastern Federal District – 28 (6.6%). After the implementation of the Algorithm in clinical practice, the number of patients referred for consultation with a pediatric oncologist increased, which was noted by 61.9±2.4% of respondents. In this case, the Algorithm is used by 11.3±1.5% of the respondents, sometimes used by 12.6±1.6%, used if they are suspected of having an oncological disease by 21.9±2.0%. Among those who do not apply the Algorithm in clinical practice, 78.1±2.0% indicated that they had not received it before.Conclusion. A survey showed the feasibility of introducing into clinical practice the “Algorithm for determining the feasibility of referring a patient for consultation with a pediatric oncologist”.

scholarly journals Low Vitamin D Level in Saudi Women With Polycystic Ovary Syndrome

2021 ◽  
Vol 8 ◽  
Author(s):  
Iman Abdullah Bindayel
Keyword(s):  
Vitamin D ◽  
Polycystic Ovary Syndrome ◽  
Polycystic Ovary ◽  
Serum Triglyceride ◽  
Reproductive Age ◽  
Ovary Syndrome ◽  
Hydroxyvitamin D ◽  
Saudi Women ◽  
Number Of Patients ◽  
Vitamin D Levels

Polycystic ovary syndrome (PCOS) is a common endocrine disorder in women of reproductive age. In this study, serum 25-hydroxyvitamin D levels were compared between women with and without PCOS and with regard to anthropometric indices and lipid and glucose biomarkers. Thirty-one women with PCOS and 75 controls answered a questionnaire on vitamin D, in addition to general health and lifestyle. The patients with PCOS had lower vitamin D levels (p &lt; 0.05), a significantly higher rate of obesity (p &lt; 0.05), and significantly higher serum triglyceride levels than did controls. The number of patients with PCOS consumed milk and dairy products (p &lt; 0.05) and exposed to sun (p &lt; 0.006) were lower compared to controls. Triglyceride levels were significantly correlated with body mass index (BMI); vitamin D level was not significantly correlated with anthropometrical or biochemical variables. These results affirm that vitamin D levels are lower in women with PCOS; however, despite the significantly higher proportion of obesity among patients with PCOS, hypovitaminosis was not associated with BMI. The relationship between body composition and vitamin D in PCOS and the effect of vitamin D correction on metabolic and hormonal parameters associated with PCOS must be assessed in future trials.

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