【医学英文精品课件】neral Medicine Update.pptVIP

Method Detailed review of evidence since 2002 Clinical trials related to benefits All study designs related to harms Panel discussion with public input opportunities Final recommendations based on confidence and degree of apparent benefits and harms Results - Recommendations AGAINST routine screening age 40-49 average risk BIENNIAL (not every 1-2 years) screening age 50-74 NO RECOMMENDATION age 74 AGAINST BSE NO RECOMMENDATION for CBE NO RECOMMENDATION for digital mammography or MRI Limitations Does not address higher-risk women or men Remains contentious An SGIM workshop was about equally divided on the age 40-49 recommendation Implications The value of breast cancer screening is getting better defined Harms are more clear Benefits in some groups are small Treatment of non-screen-detected breast cancer is improving The issue is problematic Differing views of other prominent organizations ACS recommends annual mammogram starting at 40, CBE starting at 20, and optional BSE Women (and men) have preferences and expectations I am using USPSTF statement as starting point for negotiation My major concern is the women who are not getting even that * * * * * * * * * * * * * * * More Results NNT to prevent 1 death = 200 Limitations Database study Insufficient detail to determine why subjects did/didn’t get antibiotics Cohort Study Obvious confounding opportunities Might expect more seriously ill patients to receive antibiotics Did not identify subgroups who did/didn’t get the benefits Implications Antibiotics may be more helpful than I previously thought for hospitalized COPD patients Academic centers have been less inclined to use antibiotics in this setting I will be substantially more inclined to use them Recall last year’s report of importance of antibiotics for “chest infections” The Ratty Renal Artery Revascularization versus medical therapy for renal-artery stenosis NEJM, November 2009 The ASTRAL investigators Funded by UK government and Medtronic Purpose Determine w