Prevention & Health Maintenance Flashcards
what is considered high level of certainty regarding benefit?
The available evidence usually includes consistent results from well-designed, well-conducted studies in representative primary care populations. These studies assess the effects of the preventive service on health outcomes. This conclusion is therefore unlikely to be strongly affected by the results of future studies
what is considered moderate level of certainty regarding benefit?
The available evidence is sufficient to determine the effects of the preventive service on health outcomes, but confidence in estimate is constrained by factors:
- number, size, or quality of individual studies
- inconsistency of findings across individual studies
- limited generalizability of findings to routine primary care practice
- lack of coherence in the chain of evidence
As more info becomes available, magnitude/direction of the observed effect could change, and this change may be large enough to alter the conclusion
what is considered low level of certainty regarding benefit
The available evidence is insufficient to assess the effects on health outcomes. Evidence is insufficient because of:
- The limited number/size of studies
- Important flaws in study design or methods
- inconsistency of findings across individual studies
- Gaps in chain of evidence
- Findings not generalizable to routine primary care
- Lack of info on important health outcomes
More info may allow estimation of effects on health outcomes
the leading preventable cause of disease, disability, and death in the United States
tobacco
USPSTF recommendations for aspirin for CRC prevention?
not recommended
USPSTF recommendations for CRC screening
USPSTF recommends against screening in people older than 85 years
how to prevent Common Causes of Hospitalizations (7)
Reduce illness
- supplements
- vaccines
- wellness checks
- comprehensive evaluation
- reduce falls by providing assistance
- taking their meds
- nutritional status
What resources could you use to prevent common causes of hospitalizations?
- Comprehensive Geriatric Assessment
- CDC – Older Persons’ Health
- CDC – Injury-related visits to the ED
- Federal Interagency Forum on Aging Related Statistics
- Older Americans Key Indicators of Well-Being 2020
- National Institute on Aging (part of NIH)
most agree though that prostate cancer screening men with a life expectancy of what is not recommended b/c they have little chance for any potential survivor benefit
< 10 years
what examination is not recommended for prostate cancer screenings?
DRE
what is the main issue with screenings?
cannot have a “one size fits all” approach based solely on age
medical conditions, life expectancy, and goals of treatment requires a more thoughtful and individualized application of prevention guidelines
4 things to consider with screenings
- Framework for individualized decision making is anchored by considering life expectancy
- Persons w/ comorbid medical conditions/functional impairments have a life expectancy < average for their age
- risk of experiencing adverse effects of a condition and potential benefit from early detection should be considered in the context of a person’s life expectancy
- Assess view about potential harms and benefits, and integrate their values and preferences into screening decisions
5 Steps to individualize decision making for screening tests
- Estimate life expectancy
- Estimate risk of dying from condition
- Determine potential benefit of screening
- Weigh direct and indirect harms of screening
- Assess pt’s values and preferences
Decisions to stop screening should be individualized based on whether a woman has comorbidities that limit her life expectancy to what
< 5 years
How can breast cancer screen cause more harm?
If limited life expectancy, screening can cause harm:
- false-positive results with cascade of testing
- psychological stress
- limited survival benefit
Identify clinical situations in which life expectancy, functional status, and patient preference should override standard recommendations for screening tests
I think basically if life expectancy is < 10 yrs then it’s a maybe/no screening
EXCEPT cervical - always a “no” if >65 y/o (If no previous screening or at high risk for cervical cancer (ie, immunosuppressed), discuss preferences)
IDK
