Prospective cohort study of vitamin D deficiency in pregnancy: Prevalence and limited effectiveness of 1000 IU vitamin D supplementation.

BACKGROUND: Vitamin D deficiency is highly prevalent worldwide among pregnant women. Although vitamin D supplementation is effective in improving vitamin D status, the safety and optimal dosing of vitamin D supplementation during pregnancy remain less well understood. OBJECTIVE: This study aimed to investigate the prevalence of vitamin D deficiency among pregnant women and evaluate the effectiveness of vitamin D supplementation in improving vitamin D status during pregnancy. DESIGN: This prospective cohort study assessed the impact of a 16-week daily vitamin D supplementation 1000 IU regimen on vitamin D status among pregnant women. METHODS: A total of 365 pregnant women were recruited, and their baseline total circulating 25-hydroxy vitamin D concentrations were measured. Of these, 249 participants completed the study, which involved oral daily supplementation with 1000 IU of vitamin D and a repeat of total circulating 25-hydroxy vitamin D concentrations after 16 weeks. RESULTS: The study found that 57.7% of the participants had vitamin D deficiency, consistent with the rates reported in other studies. However, vitamin D supplementation at a dose of 1000 IU had a small effect size and was not clinically significant. However, 67% of participants with vitamin D deficiency remained deficient; among participants initially with vitamin D insufficiency, 30% became deficient. Moreover, 26.5% of individuals with sufficient vitamin D status at 12 weeks showed insufficient levels by 28 weeks. CONCLUSION: Vitamin D deficiency is widespread among pregnant women, and vitamin D supplementation at a daily dose of 1000 IU may not adequately address this problem. Although the study has limitations, its results align with previous research and may apply to other populations with a high prevalence of vitamin D deficiency during pregnancy. Further research is necessary to determine the most effective approach for addressing prenatal vitamin D deficiency.

Prevalence and effectiveness of vitamin D supplementation during pregnancyVitamin D deficiency is common among pregnant women and can lead to various health issues. This study aimed to investigate the effectiveness of vitamin D supplementation in improving vitamin D levels during pregnancy. A total of 365 pregnant women were recruited, and their vitamin D levels were measured at the beginning of the study. The participants were given a daily vitamin D supplement of 1000 IU, and their vitamin D levels were measured at 3-month intervals. The study found that more than half of the participants had vitamin D deficiency, which is consistent with the rates reported in other studies. However, vitamin D supplementation at the given dosage had a small effect and did not significantly increase vitamin D levels in pregnant women. Moreover, vitamin D-rich diets had no significant impact on vitamin D levels. The study emphasizes the importance of identifying effective strategies for preventing and treating vitamin D deficiency during pregnancy. The findings suggest that current strategies advised by international and national guidelines may not be sufficient to address the problem. Further research is needed to identify more effective approaches, including screening, higher safe dosages, and monitoring responses after 3 months of treatment. In summary, vitamin D deficiency is common among pregnant women, and current strategies may not be enough to address the issue. The study highlights the need for effective approaches to prevent and treat vitamin D deficiency during pregnancy, and further research is needed to find these strategies.

Teaching Benign Paroxysmal Positional Vertigo to Emergency Medicine Residents by Using Gagne's Nine Steps of Instructional Design.

INTRODUCTION: Patients commonly seek medical advice with dizziness symptoms. One of the common subtypes of dizziness is benign paroxysmal positional vertigo (BPPV). The American Academy of Neurology recommends that physicians should be trained in the physical maneuvers for the treatment of BPPV. METHODOLOGY: The study participants were educated about BPPV using Gagne's instructional strategy. Before and after the education, three parameters were used for assessing their knowledge and skills about BPPV. Twenty MCQs for knowledge assessment and two skill stations, Dix-Hallpike test (DH) and canalith repositioning maneuver (CR) were used. An experienced emergency medicine (EM) faculty supervised the assessment. RESULTS: Nineteen EM residents participated in the study; mean age was 28.4 years (±1.7). Twelve (63.15%) were male, and seven (36.9%) were female. The median score before the course for the DH test was 2 (1.7-3.0) and improved to 5(4.0-5.0). Similarly, CR's median score improved from 2 (1.0-2.3) to 5 (4.7-5.0). Both of these skills improved by 60%. Pre-intervention MCQs mean score was 15.2 (14.4-16.1), which increased to 18.0 (17.4-18.6). MCQs improvement was recorded as 14%. CONCLUSION: The educational plan delivered by utilizing the Gagne's instructional design has resulted in significant improvement of the knowledge about BPPV.

Curing Benign Paroxysmal Positional Vertigo (BPPV) Through Telehealth: A Case Series.

Benign paroxysmal positional vertigo (BPPV) is a common medical condition in which the patient feels a spinning sensation when making certain head movements. There is evidence to support those free-floating calcium crystals in the semi-circular canals (the inner ear) may be the cause. BPPV can be a disabling condition. It can be easily diagnosed after taking a careful history and performing bedside examinations. BPPV can be treated successfully through a specific set of physical maneuvers leading to the removal of these crystals from the inner ear. We present three cases of BPPV, living in three different countries, treated successfully using telehealth via Zoom. This approach can be a particularly useful consultation stand during the coronavirus disease 2019 (COVID-19) pandemic.

Challenges of Providing Palliative Care to a Patient With Learning Disability: A Case Study From United Kingdom General Practice.

Palliative care is a complex and challenging field in the healthcare profession. In the United Kingdom (UK), palliative care provision is part of everyday work for General Practitioners (GPs). The UK General Practice Curriculum includes palliative care as a core competency to be achieved to become a fully certified GP/family physician. The various stages of a patient's journey from getting a life-limiting diagnosis to breaking bad news, and dealing with the treatments and resulting complications need active involvement from the patient and their loved ones with healthcare professionals at all times. It becomes more challenging if the patient has impaired mental capacity and cannot make his independent decisions as a result. The interplay of patient's wishes, the wishes of immediate relatives, the law of the land and clinician's role in becoming an advocate to safeguard patient's best interest has significant implications for all stakeholders and far-reaching consequences. This case study elaborates on some of the challenges in the delivery of palliative care in a complex situation and provides knowledge base to bridge those flaws.

Case-Based Discussion in United Kingdom General Practice Training: A Critical Analysis.

Case-based discussion (CbD) is a form of workplace-based assessment to assess the progress of learning in general practice trainees in the United Kingdom. We aim to identify the need and rationale behind CbD. The usefulness of CbD in the trainee's learning will be analyzed with the help of well-recognized parameter such as utility equation. It will also be considered whether the assessment delivers what it is supposed to in actual practice. The current pitfalls will be identified with suggestions for potential improvements.