Acute changes in the systemic inflammatory response are associated with transient decreases in circulating 25-hydroxyvitamin D concentrations following elective knee arthroplasty [POSTER]

No abstract available

Acute changes in the systemic inflammatory response are associated with transient decreases in circulating 25-hydroxyvitamin D concentrations following elective knee arthroplasty [POSTER]

No abstract available

Outcomes of pregnancy complicated by thyroid disease

AIMS: To perform a case note review of pregnancies complicated by thyroid dysfunction to determine management and therapeutic intervention in relation to pregnancy outcome. METHODS: A retrospective case note analysis of 81 ongoing pregnancies in 70 pregnant women with a history of thyroid dysfunction over a period of 5 years at the Glasgow Royal Maternity Hospital (GRMH), Glasgow, Scotland, United Kingdom. The results of thyroid function tests and whether a change in treatment was instituted were recorded. Thyroid function was assessed by standard laboratory reference ranges for free thyroxine (FT4) and thyroid stimulating hormone (TSH) in all trimesters. Other parameters were also noted. RESULTS: Medication levels needed to be increased in the hypothyroid group (45%), and decreased (38%) in the hyperthyroid group. CONCLUSION: Pregnancy outcome was good in majority of cases given appropriate replacement therapy for stated reference values

The introduction of a chest pain nurse and fast-track troponin service reduces the length of stay of patients presenting with chest pain.

Background Troponin I (TnI) measurement is important in decision making and management of patients who present with chest pain. Undetectable levels of TnI in these patients are associated with a low risk of death or myocardial infarction at 30 days, and may allow early discharge from hospital. Methods An audit was performed tracking patients who presented with chest pain and had a TnI blood test requested. Routine clinical service was audited for three months. A "fast-track" troponin service and chest pain specialist nurse was then introduced to assist in the management of patients. This was continued for three months to assess the impact on length of stay. Results 446 patients were admitted during the first three month period and 511 patients admitted during the second monitoring period when the new measures were introduced. The time from chest pain onset until the TnI blood test was taken reduced from 23.0 hours to 20.3 hours. The percentage of patients admitted to hospital wards from the Acute Medical Receiving Unit (AMRU) fell from 62% to 53% (p < 0.001). The new measures resulted in a reduction in admission time from 73.1 hours to 51.0 hours. Conclusion A fast-track troponin and specialist nurse achieved a reduction of nearly 24 hours in length of stay in patients presenting with chest pain. This would result in a saving of approximately 2000 bed-days per annum, releasing 5-6 acute beds per day

The introduction of a chest pain nurse and fast-track troponin service reduces the length of stay of patients presenting with chest pain

Background Troponin I (TnI) measurement is important in decision making and management of patients who present with chest pain. Undetectable levels of TnI in these patients are associated with a low risk of death or myocardial infarction at 30 days, and may allow early discharge from hospital. Methods An audit was performed tracking patients who presented with chest pain and had a TnI blood test requested. Routine clinical service was audited for three months. A "fast-track" troponin service and chest pain specialist nurse was then introduced to assist in the management of patients. This was continued for three months to assess the impact on length of stay. Results 446 patients were admitted during the first three month period and 511 patients admitted during the second monitoring period when the new measures were introduced. The time from chest pain onset until the TnI blood test was taken reduced from 23.0 hours to 20.3 hours. The percentage of patients admitted to hospital wards from the Acute Medical Receiving Unit (AMRU) fell from 62% to 53% (p < 0.001). The new measures resulted in a reduction in admission time from 73.1 hours to 51.0 hours. Conclusion A fast-track troponin and specialist nurse achieved a reduction of nearly 24 hours in length of stay in patients presenting with chest pain. This would result in a saving of approximately 2000 bed-days per annum, releasing 5-6 acute beds per day

The relation between acute changes in the systemic inflammatory response and plasma 25-hydroxyvitamin D concentrations after elective knee arthroplasty

Background: Studies indicate that low plasma 25-hydroxyvitamin D [25(OH)D] is associated with a range of disease processes, many of which are inflammatory. However, other lipid-soluble vitamins decrease during the systemic inflammatory response, and this response may confound the interpretation of plasma 25(OH)D. Objective: The objective was to examine whether plasma 25(OH)D concentrations change during evolution of the systemic inflammatory response. Design: Patients (n = 33) who underwent primary knee arthroplasty had venous blood samples collected preoperatively and postoperatively (beginning 6-12 h after surgery and on each morning for 5 d) for the measurement of 25(OH)D, vitamin D-binding protein, parathyroid hormone (PTH), calcium, C-reactive protein, and albumin. A final sample was collected at 3 mo. Results: Preoperatively, most patients were 25(OH)D deficient (<50 nmol/L) and had secondary hyperparathyroidism (PTH. 5 pmol/L). Age, sex, body mass index, season, medical history, and medication use were not associated with significant differences in preoperative plasma 25(OH)D concentrations. By day 2 there was a large increase in C-reactive protein concentrations (P < 0.001) and a significant decrease in 25(OH)D of approximate to 40% (P < 0.001). C-reactive protein, 25(OH)D, and calculated free 25(OH)D had not returned to preoperative concentrations by 5 d postoperatively (all P < 0.001). At 3 mo, 25(OH)D and free 25(OH)D remained significantly lower (20% and 30%, respectively; P < 0.01). Conclusion: Plasma concentrations of 25(OH)D decrease after an inflammatory insult and therefore are unlikely to be a reliable measure of 25(OH)D status in subjects with evidence of a significant systemic inflammatory response