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Vitamin D Testing in the General Population: A Review of the Clinical and Cost-Effectiveness and Guidelines [Internet]

Rising awareness about the potential link between vitamin D deficiency and adverse health outcomes has seen an increase in the rate of vitamin D testing in developed countries. The cost of a single vitamin D test is moderate (e.g., $61.32 in British Colombia) but the elevated testing rate contributes to substantial healthcare costs. Concern over rising costs led to reform in testing coverage in 2010 in Ontario, followed by other provinces. The changes in Ontario were based on a 2010 report by the Ontario Health Technology Advisory Committee (OHTAC) on the clinical utility of vitamin D testing (reviewed in this report). Despite a lack of direct evidence on testing, a recommendation was made against providing testing for the general population. Tests are now indicated only for individuals with specific conditions (i.e., osteoporosis, rickets, osteomalacia, malabsorption syndromes, renal disease, and individuals taking medications that may affect vitamin D status). The Endocrine Society and Osteoporosis Canada also recommend against screening for low risk individuals. There is a lack of evidence to suggest that the rise in test frequency has translated into improved healthcare practices. For example, the temporal increase in testing in Australia has not resulted in improved osteoporosis detection in women aged 45 to 74. There is also a lack of evidence on the cost-effectiveness of testing. In light of the rise in test frequency, assay and cut-off inconsistency, and the lack of evidence for the utility of testing, this report will investigate the clinical and cost-effectiveness of testing in the general population.

Rapid Response Report: Summary with Critical Appraisal - Canadian Agency for Drugs and Technologies in Health.

Version: January 16, 2015
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Lactose Intolerance and Health

We systematically reviewed evidence to determine lactose intolerance (LI) prevalence, bone health after dairy-exclusion diets, tolerable dose of lactose in subjects with diagnosed LI, and management.

Evidence Reports/Technology Assessments - Agency for Healthcare Research and Quality (US).

Version: February 2010
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Vitamins for epilepsy

No evidence that folic acid, thiamine, vitamin D or vitamin E improve seizure control or prevent side effects for people with epilepsy.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Vitamin D supplementation in pregnancy: a systematic review

Study found insufficient evidence to support definite clinical recommendations regarding vitamin D supplementation in pregnancy. Although there is modest evidence to support a relationship between maternal 25-hydroxy vitamin D [25(OH)D] status and offspring birthweight, bone mass and serum calcium concentrations, these findings were limited by their observational nature (birthweight, bone mass) or risk of bias and low quality (calcium concentrations).

Health Technology Assessment - NIHR Journals Library.

Version: July 2014
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Coeliac Disease: Recognition, Assessment and Management

Coeliac disease is an autoimmune condition associated with chronic inflammation of the small intestine, which can lead to malabsorption of nutrients. Dietary proteins, known as glutens, which are present in wheat, barley and rye activate an abnormal mucosal immune response. Clinical and histological improvements usually follow when gluten is excluded from the diet.

NICE Guideline - Internal Clinical Guidelines Team (UK).

Version: September 2015
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Vitamin D for the Treatment or Prevention of Multiple Sclerosis: A Review of the Clinical Effectiveness [Internet]

This report will review evidence investigating the uncertainty surrounding the clinical effectiveness of vitamin D supplementation for both the prevention and treatment of multiple sclerosis (MS) in adults.

Rapid Response Report: Summary with Critical Appraisal - Canadian Agency for Drugs and Technologies in Health.

Version: March 10, 2016
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Screening for Vitamin D Deficiency: Systematic Review for the U.S. Preventive Services Task Force Recommendation [Internet]

It is unclear if screening for vitamin D deficiency can improve the health of asymptomatic individuals with this deficiency.

Evidence Syntheses - Agency for Healthcare Research and Quality (US).

Version: November 2014
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Hepatitis B (Chronic): Diagnosis and Management of Chronic Hepatitis B in Children, Young People and Adults

Chronic hepatitis B describes a spectrum of disease usually characterised by the presence of detectable hepatitis B surface antigen (HBsAg) in the blood or serum for longer than 6 months. In some people, chronic hepatitis B is inactive and does not present significant health problems, but others may progress to liver fibrosis, cirrhosis and hepatocellular carcinoma (HCC). The progression of liver disease is associated with hepatitis B virus (HBV) DNA levels in the blood. Without antiviral treatment, the 5-year cumulative incidence of cirrhosis ranges from 8 to 20%. People with cirrhosis face a significant risk of decompensated liver disease if they remain untreated. Five-year survival rates among people with untreated decompensated cirrhosis can be as low as 15%. Chronic hepatitis B can be divided into e antigen- (HBeAg) positive or HBeAg-negative disease based on the presence or absence of e antigen. The presence of HBeAg is typically associated with higher rates of viral replication and therefore increased infectivity.

NICE Clinical Guidelines - National Clinical Guideline Centre (UK).

Version: June 2013
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Chronic Kidney Disease (Partial Update): Early Identification and Management of Chronic Kidney Disease in Adults in Primary and Secondary Care

The Renal National Service Framework (NSF), and the subsequent NICE Clinical Practice Guideline for early identification and management of adults with chronic kidney disease (CKD) in primary and secondary care (CG73), served to emphasise the change in focus in renal medicine from treatment of established kidney disease to earlier identification and prevention of kidney disease.

NICE Clinical Guidelines - National Clinical Guideline Centre (UK).

Version: July 2014
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Antenatal Care: Routine Care for the Healthy Pregnant Woman

The original antenatal care guideline was published by NICE in 2003. Since then a number of important pieces of evidence have become available, particularly concerning gestational diabetes, haemoglobinopathy and ultrasound, so that the update was initiated. This update has also provided an opportunity to look at a number of aspects of antenatal care: the development of a method to assess women for whom additional care is necessary (the ‘antenatal assessment tool’), information giving to women, lifestyle (vitamin D supplementation, alcohol consumption), screening for the baby (use of ultrasound for gestational age assessment and screening for fetal abnormalities, methods for determining normal fetal growth, placenta praevia), and screening for the mother (haemoglobinopathy screening, gestational diabetes, pre-eclampsia and preterm labour, chlamydia).

NICE Clinical Guidelines - National Collaborating Centre for Women's and Children's Health (UK).

Version: March 2008
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Diagnosis of Celiac Disease [Internet]

To report the evidence on comparative accuracy and safety of methods used in current clinical practice to diagnose celiac disease, including serological tests, human leukocyte antigen (HLA) typing, and video capsule endoscopy. Diagnostic tests used singly and in combination in various populations were compared against the reference standard of endoscopic duodenal biopsy. In addition, factors affecting biopsy accuracy were reviewed.

Comparative Effectiveness Reviews - Agency for Healthcare Research and Quality (US).

Version: January 2016
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Systematic review of the use of bone turnover markers for monitoring the response to osteoporosis treatment: the secondary prevention of fractures, and primary prevention of fractures in high-risk groups

Study found insufficient evidence to support the use of bone turnover markers in routine clinical practice for monitoring osteoporosis treatment response. Only five studies identified were randomised controlled trials; none assessed cost-effectiveness and none evaluated the clinical effectiveness of bone turnover marker monitoring for treatment management. The results were inconsistent and inconclusive, and a decision-analytic model was not developed. Further research is needed.

Health Technology Assessment - NIHR Journals Library.

Version: February 2014
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Total hip replacement and surface replacement for the treatment of pain and disability resulting from end-stage arthritis of the hip (review of technology appraisal guidance 2 and 44): systematic review and economic evaluation

Study found that patients’ hip function and their general quality of life improved after having either total hip replacement (THR) or resurfacing arthroplasty (RS), with certain types of THR showing some benefit over others. More hip RSs had to be revised than THRs with costs for RS higher than those for THR.

Health Technology Assessment - NIHR Journals Library.

Version: January 2015
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Ulcerative Colitis: Management in Adults, Children and Young People [Internet]

Ulcerative colitis is the most common type of inflammatory disease of the bowel. It has an incidence in the UK of approximately 10 per 100,000 people annually,and a prevalence of approximately 240 per 100,000. This amounts to around 146,000 people in the UK with a diagnosis of ulcerative colitis. The cause of ulcerative colitis is unknown. It can develop at any age, but peak incidence is between the ages of 15 and 25 years, with a second, smaller peak between 55 and 65 years (although this second peak has not been universally demonstrated). The British Paediatric Surveillance Unit reported an incidence of ulcerative colitis in children aged younger than 16 years in the United Kingdom, of 1.4 per 100,000 with a greater proportion of Asian children having ulcerative colitis than other children. The median age for diagnosis of ulcerative colitis overall in this childhood cohort was 11.7 years (range 9.3 to 13.7 years).

NICE Clinical Guidelines - National Clinical Guideline Centre (UK).

Version: June 2013
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An Evidence Synthesis of Qualitative and Quantitative Research on Component Intervention Techniques, Effectiveness, Cost-Effectiveness, Equity and Acceptability of Different Versions of Health-Related Lifestyle Advisor Role in Improving Health

There is a need to identify and analyse the range of models developed to date for delivering health-related lifestyle advice (HRLA), or training, for effectiveness and cost-effectiveness in improving the health and well-being of individuals and communities in the UK, with particular reference to the reduction of inequalities.

Health Technology Assessment - NIHR Journals Library.

Version: February 2011
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Effectiveness and Safety of Antiepileptic Medications in Patients With Epilepsy [Internet]

This is an evidence report prepared by the University of Connecticut/Hartford Hospital Evidence-based Practice Center examining the comparative efficacy, safety, and tolerability of newer versus older and innovator versus generic antiepileptic medications.

Comparative Effectiveness Reviews - Agency for Healthcare Research and Quality (US).

Version: December 2011
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Complementary and Alternative Therapies for Back Pain II

Back and neck pain are important health problems with serious societal and economic implications. Conventional treatments have been shown to have limited benefit in improving patient outcomes. Complementary and Alternative Medicine (CAM) therapies offer additional options in the management of low back and neck pain. Many trials evaluating CAM therapies have poor quality and inconsistent results.

Evidence Reports/Technology Assessments - Agency for Healthcare Research and Quality (US).

Version: October 2010
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Systematic Reviews in PubMed

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