The edition · Family Medicine
Stop testing vitamin D in well adults
A primary care review finds no trial support for screening or supplementing healthy adults; simple tests sort male urinary symptoms; loneliness predicts a worse course of depression.
The edition in brief
An American Family Physician review concludes that the trial evidence does not support screening for or supplementing vitamin D in community-dwelling adults, whatever the baseline level: randomised trials show no consistent benefit for mortality, cardiovascular disease, falls, fractures, cancer, mood, fatigue or pain. Recommended intake is 600 IU a day to age 70 and 800 IU after; a possible exception is prediabetes, where longer, higher-dose supplementation may reduce progression. A BJGP diagnostic study in 601 men with lower urinary tract symptoms across 67 practices found that a combination of simple tests — symptom score, bladder diary, examination, PSA, flow rate and residual volume — identified bladder outlet obstruction well against urodynamics, with a C index of about 0.8, but was weaker for detrusor problems. A cluster-randomised trial of a web-based musculoskeletal decision-support tool in UK practices found far less non-evidence-based care when it was used, but it was used in under one consultation in ten. A meta-analysis links loneliness to more than three times the odds of a poor depression course in older adults. A Canadian analysis ties clinic continuity to lower acute-care costs. The pearl covers the red flags in male urinary symptoms.
Simple tests that sort male urinary symptoms
A structured primary care work-up can identify likely bladder outlet obstruction in men with LUTS without urodynamics.
A musculoskeletal decision aid works when anyone uses it
Musculoskeletal decision support improved care when used, but uptake, not content, is the problem to solve.
Loneliness predicts a worse course of depression
Ask about loneliness in patients with depression and treat it as a reason for closer follow-up.
Clinic continuity and the cost of chronic disease
Keep complex chronic-disease patients with one clinic team wherever possible.
Red flags in male urinary symptoms
Exclude haematuria, an abnormal prostate, retention and neurological causes before managing LUTS in primary care.
Vitamin D: test less, supplement less
Stop routine vitamin D testing and supplementation in healthy adults; recommend the daily intake instead.
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