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Overview of multi morbidity and the challenge for EBM

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Overview of multi morbidity and the challenge for EBM

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How can guidelines tackle multimorbidity?

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Alan Lovell, information services manager for Bazian, discusses multimorbidity and the challenges it poses for evidence-based medicine. Learn more about Bazian: http://www.bazian.com/ Follow Bazian on Twitter: https://twitter.com/BazianLtd

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Who and how you should assess fracture risk

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The 'gold standard' for diagnosing osteoporosis is by measuring bone mineral density (BMD) using dual X-ray absorptiometry (DXA) and comparing the patient's result with that of a young adult of the same sex. In terms of SDs relative to the young adult normal, this is known as the T-score.

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Understanding vitamin D and Osteoporosis

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Understanding vitamin D and Osteoporosis

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What the tests mean nd why they are need in the community

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National vitamin D guidelines
Vitamin D and Bone Health: A Practical Clinical Guideline for Patient Management
Guidelines on vitamin D supplementation have been published by the NOS. These have been endorsed by the Royal College of Nursing, Bone Research Society, British Dietetic Association, Paget's Association, International Osteoporosis Foundation, UK Clinical Pharmacology Association, Primary Care Rheumatology Society, Royal Pharmaceutical Society, British Orthopaedic Association and the Society for Endocrinology.

These guidelines do not address supplementation in pregnant women, although this is covered in NICE guidance.

Who to treat

The recommended definition of deficiency made for adopting into UK practice is:

Serum 25OHD

Serum 25OHD of 30 - 50 nmol/L may be inadequate in some people

Serum 25OHD > 50 nmol/L is sufficient for almost the whole population

Following measurement of serum 25OHD, consider:

Fragility fracture, documented osteoporosis or high fracture risk

Treatment with anti-resorptive medication for bone disease

Symptoms suggestive of vitamin D deficiency

Increased risk of developing vitamin D deficiency in the future because of reduced exposure to sunlight, religious dress code, dark skin, etc

Raised parathyroid hormone levels

Medication with anti-epileptic drugs or oral glucocorticoids

Conditions associated with malabsorption

In patients whose tests show they have sufficient vitamin D levels (> 50 nmol/L) the recommendations are to give lifestyle advice on maintaining adequate vitamin D levels through safe sunlight exposure and diet. For more information, see the Initiation section of this resource.

How to treat vitamin D deficiency

The key aims of treatment are:

Using adequate doses to ensure correction of vitamin D deficiency (to > 50 nmol/L)

Timely reversal of the clinical consequences of vitamin D deficiency

Avoiding toxicity

Oral vitamin D3 is recommended as the treatment of choice in vitamin D deficiency.

Where rapid correction of vitamin D deficiency is required, such as in patients with symptomatic disease or about to start treatment with a potent antiresorptive agent (zoledronate or denosumab), the recommended treatment regimen is based on fixed loading doses followed by regular maintenance therapy:

a loading regimen to provide a total of approximately 300,000 IU vitamin D, given either as separate weekly or daily doses over 6 to 10 weeks

maintenance therapy comprising vitamin D in doses equivalent to 800 - 2000 IU daily daily (occasionally up to 4,000 IU daily), given either daily or intermittently at higher doses.

Where correction of vitamin D deficiency is less urgent and when co-prescribing vitamin D supplements with an oral anti-resorptive agent, maintenance therapy may be started without the use of loading doses.

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How should GPs assess vitamin D deficiency?

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Vitamin D and Bone Health: A Practical Clinical Guideline for Patient Management Guidelines on vitamin D supplementation have been published by the NOS. These have been endorsed by the Royal College of Nursing, Bone Research Society, British Dietetic Association, Paget's Association, International Osteoporosis Foundation, UK Clinical Pharmacology Association, Primary Care Rheumatology Society, Royal Pharmaceutical Society, British Orthopaedic Association and the Society for Endocrinology.

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Cancer survival is now a long term condition

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How the cancer story is changing | The Royal College of Radiologists

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Professor Jane Maher describes how the story of cancer is changing through the unique lens of a late-onset rock chick. Professor Maher uses the experiences of rock stars to explain how cancer is being treated, how the patients are being supported, and how the public is being made aware.

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Useful BMJ infographic on multi morbidity

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Useful BMJ infographic on multi morbidity

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http://www.bmj.com/content/bmj/suppl/2016/09/21/bmj.i4843.DC1/farc050916.w2_default.pdf

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BJ Miller: What really matters at the end of life

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At the end of our lives, what do we most wish for? For many, it's simply comfort, respect, love. BJ Miller is a hospice and palliative medicine physician who thinks deeply about how to create a dignified, graceful end of life for his patients.

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Palliative care guidelines Plus link to network guidance. its interactive so you can search on clinical topics

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Palliative care guidelines Plus link to network guidance. its interactive so you can search on clinical topics

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https://book.pallcare.info/

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Update for type 2 diabetes infographic and prescribing guidance

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Update for type 2 diabetes infographic and prescribing guidance

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http://www.bmj.com/content/353/bmj.i1575

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Dan Lasserson GP and researcher CKI and multi morbidity

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Dan Lasserson GP and researcher CKI and multi morbidity

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Chronic Kidney Disease - lecture by Dr Dan Lasserson

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Dr Dan Lasserson, senior clinical researcher and GP, on why research into Chronic Kidney Disease is increasing in importance.

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Mood information prescription

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KSS AHSN breathing bundle e learning resource