Hi.
Been a "quiet member" for some time. Just "listening" here. Wonder if the
following might add to your discussion:
http://text.nlm.nih.gov/nih/cdc/www/67txt.html
Much of the literature with which I am familiar states that doses greater
than 2000mg/day (http://www.menopause-online.com/calcium.htm) are
associated with kidney stones.
And --- http://www.cma.ca/disease/osteo_p1/no4.htm#risks
Mark
At 11:14 AM 2/6/1999 +0000, Toby Lipman 7, Collingwood Terrace, Jesmond,
Newcastle upon Tyn wrote:
>In message <[log in to unmask]>, Adrian Midgley
><[log in to unmask]> writes
>
>(snip of interesting problem)
>>
>>So, the questions I set myself were:-
>>
>> - what is her absolute risk of hip vertebral or other significant
>>fracture?
>>
>> - what is the risk of her getting a stone due to taking the calcium
>>supplement?
>>
>>In order that we could at least deal with some numbers instead of
>>vague generalisations.
>>
>>I looked at Pubmed and found several hits, but not to thngs I have
>>available.
>>http://www.hon.ch/ gave me a couple of sites which make references
>>to the change in risk of stones with Calcium supplementation,
>>including one paper that is reported to have found a _reduced_ risk
>>of stone in men with a high intake.
>>
>>I don't feel I am doing very well at this, and yet it should be a
>>fairly common question to look for an answer to.
>>
>Adrian I think you are doing absolutely fine your questions are spot on.
>The problems you have are the same most of us have:
>
>Even if we have access to databases (which a lot of us don't - at least
>at the time and place we need them) we find it difficult to search
>effectively. The answer to that is practice and be ready to seek help.
>I'd first look at Trish Greenhalgh's section on searching in "How to
>read a paper" which gives lots of useful tips. I'd also like to be
>really friendly with a librarian who I could just ring or e-mail and get
>some advice!
>
>Most of us can access Cochrane, Best Evidence and Medline and it's also
>worth looking at the Bandolier website http://www.jr2.ox.ac.uk/Bandolier
>
>I'd probably start with Best Evidence on the basis that if I hit lucky
>the information is presented in such a way that I can use it
>immediately. Cochrane is great and comprehensive for therapy.
>
>The big problem is when you realise you need the full text. It's just
>not practical to go to the postgrad centre and photocopy the paper each
>time. Sometimes you can be fortunate in having someone who will do it
>for you (for instance we are fortunate as we have a pharmacist/advisor
>who is very keen to look at the evidence and will obtain full texts if
>we ask - but she's only in once a week and we don't like to impose too
>much as it's not her job, strictly speaking, to do messages like this
>for us, so I only ask her if it's somthing she's directly involved in,
>like at the moment we're looking at short and long antibiotic courses
>for UTI)
>
>I'm increasingly irritated that IM & T implementation does not include a
>strategy for getting full texts to clinicians quickly. Those managers
>I've spoken to about it don't even understand why it might be important
>and they're more concerned with whether we've an armed guard on each PC
>before we get connected to the NHS net!
>
>We need to emphasise that getting information like this to clinicians
>quickly and routinely needs an infrastructure and is now government
>policy in the UK as part of clinical governance ("evidence-based
>practice in daily use with the infrastructure to support it")
>
>I think it'll come sooner or later, but we should all apply pressure to
>make it sooner!
>
>Cheers
>
>Toby
>--
>Toby Lipman 7, Collingwood Terrace, Jesmond, Newcastle upon Tyne. Tel
>0191-2811060 (home), 0191-2437000 (surgery)
>
>
Mark E. Abell, BS, PA-C
Freelance Med-Write
1940 SE 57th Ave
Ocala, Florida 34471
(352) 694-7215
(352) 694-7295 (Fax)
Family Medicine at The Mining Co.
http://familymedicine.miningco.com
Recipient, Hardin MD Clean Bill of Health Award, 1998
Gainesville, Florida at The Mining Co.
http://gainesville.miningco.com
C0-Moderator, PRIMARYPA Clinical discussion List
http://www.listserv.mc.duke.edu/archives/primarypa.html
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