scholarly journals Mammographic Screening in Older Women: When Is It Time to Stop?

2020 ◽  
Vol 2 (2) ◽  
pp. 92-100
Author(s):  
Reni Butler ◽  
Liane Philpotts
Keyword(s):  
Older Women ◽  
Health Care Providers ◽  
Performance Metrics ◽  
Breast Cancer Mortality ◽  
Age Groups ◽  
Mammographic Screening ◽  
Screening Mammography ◽  
Medical Community ◽  
Individual Risk ◽  
Care Providers

Abstract Mammographic screening guidelines in women aged 75 and older are inconsistent due to a lack of data from prospective randomized controlled trials, such as those that exist for women between 40–74 years of age. In addition, older women are perceived as less likely to benefit from early detection due to increased comorbidities and a greater proportion of biologically favorable cancers. With increasing life expectancy and quality of life in the elderly, the question of when to stop mammographic screening merits renewed discussion. Observational data support a survival benefit from regular screening in older women with no severe comorbidities. In addition, screening mammography in this age group has been shown to perform better than in younger age groups, tipping the balance toward greater benefits than harms. Early studies of digital breast tomosynthesis (DBT) in older women suggest that performance metrics are further improved with DBT screening. While a biennial schedule in older women preserves some of the benefit of screening, annual mammography achieves the greatest reductions in breast cancer mortality and morbidity. As the medical community strives to offer personalized care for all age groups, health care providers are well positioned to offer shared decision-making based on existing data and tailored to each woman’s individual risk profile, comorbid conditions, and personal values.

Mammography use in women age 80 and older with breast cancer

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 9039-9039
Author(s):  
S. H. Giordano ◽  
B. Badgwell ◽  
Z. Duan ◽  
I. Bedrosian ◽  
G. Hortobagyi ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Multivariate Analysis ◽  
Health Care Providers ◽  
Tumor Size ◽  
Age Groups ◽  
Breast Cancer Diagnosis ◽  
Screening Mammography ◽  
Stage Ii ◽  
Care Providers ◽  
Mammography Use

9039 Background: The guidelines for screening mammography use in patients age 80 years and older are not clear. The purpose of this study was to determine the effect of mammography use on stage and tumor size at breast cancer diagnosis. Methods: The study is a retrospective cohort using the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database. We evaluated 14,976 women aged 80 and older diagnosed with breast cancer between 1996–2002. Patients were divided into three cohorts based on screening mammography use in the 60 months prior to diagnosis: nonusers, non-regular users (1–2 mammograms), and regular users (3+). The effects of screening on tumor stage (0-I vs. II-IV) and size were determined by logistic regression and multivariate analysis of variance. Results: Regular mammography use for the age groups 80–84, 85–89, and >= 90 was 29%, 19%, and 9%, respectively. Among regular users of mammography, 26% presented with stage II or greater cancer while 64% of non-users presented with stage II or greater disease. On multivariate analysis, non-users were 4.7 (95% CI 4.26–5.14) times more likely to present with high-stage cancer. Non-users, non-regular users, and regular users had an adjusted mean tumor size of 5.08 (4.44–5.72), 3.26 (2.57–3.95), and 2.77 (2.02–3.51), respectively. Conclusions: Regular screening mammography among women aged 80 years and older is associated with earlier stage at presentation and smaller tumor size compared to mammography nonusers. Health care providers should consider discussing potential benefits of screening mammography with their older patients particularly for those without significant comorbidity. No significant financial relationships to disclose.

Genetic Predispositions, Prophylactic Treatments and Private Health Insurance: Nothing is Better Than a Good Pair of Genes

1997 ◽  
Vol 23 (1) ◽  
pp. 45-68 ◽  
Author(s):  
Alexandra K. Glazier
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Genetic Predisposition ◽  
Genetic Linkage ◽  
Dna Analysis ◽  
Care Delivery ◽  
Medical Community ◽  
Care Providers ◽  
Linkage Studies ◽  
Prophylactic Measures

Discovering the genetic basis of a particular disease is not only of great interest to the medical community; private health insurers are also anxiously awaiting the results of genetic linkage studies. Apart from the scientific value of DNA studies, the results of genetic linkage research are relevant to health care delivery in two principal ways. First, identifying the genetic origin of a disease may allow doctors to detect the disease earlier. If doctors know that an individual is genetically predisposed to a particular disease, then health care providers can increase screening efforts and watch for early symptoms. Second, if an individual has a genetic predisposition to a particular disease, health care providers may employ preventive or “prophylactic" measures to reduce or eliminate the risk of developing the disease or condition to which the individual is genetically predisposed. Genetic linkage studies will soon allow more individuals to learn of their own genetic predispositions to certain diseases. Currently genetic predisposition tests (both pedigrees of family history and DNA analysis) can indicate that an individual is at high risk for developing a disease.

Older Women's Community Mobility: A Qualitative Exploration

2002 ◽  
Vol 21 (1) ◽  
pp. 75-84 ◽  
Author(s):  
Marcia Finlayson ◽  
Joseph Kaufert
Keyword(s):  
Older Women ◽  
Health Care Providers ◽  
Community Dwelling ◽  
Care Providers ◽  
Structured Interviews ◽  
Community Mobility ◽  
Bad Weather ◽  
Qualitative Exploration ◽  
And Control ◽  
The City

ABSTRACTMany of the limitations experienced by community-dwelling older women are related to mobility within their communities. This qualitative study explored community mobility from the perspective of older, community-dwelling women in Winnipeg, Manitoba. Semi-structured interviews were completed with 23 older women (mean age 75.9 years) identified through an existing database. In addition to travels to conduct instrumental activities of daily living and participate in social and recreational activities, the women in the study described trips to fulfil social obligations (e.g., attending funerals, visiting sick friends) and emphasized the importance of these trips. The women's travels through the city were influenced by their perception of risk and the strategies they employed to minimize or avoid risk during the day, in the evening, and during bad weather. Autonomous community mobility provided the women with a sense of independence and control. The findings have potential implications for health care providers and community programmers who work to maintain older women in the community.

scholarly journals Trustworthy Augmented Intelligence in Health Care

2022 ◽  
Vol 46 (2) ◽  
Author(s):  
Elliott Crigger ◽  
Karen Reinbold ◽  
Chelsea Hanson ◽  
Audiey Kao ◽  
Kathleen Blake ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Clinical Care ◽  
Medical Community ◽  
Care Providers ◽  
Innovative Technologies ◽  
Quadruple Aim ◽  
Regulatory Systems ◽  
Starting Point ◽  
Reducing Costs

AbstractAugmented Intelligence (AI) systems have the power to transform health care and bring us closer to the quadruple aim: enhancing patient experience, improving population health, reducing costs, and improving the work life of health care providers. Earning physicians' trust is critical for accelerating adoption of AI into patient care. As technology evolves, the medical community will need to develop standards for these innovative technologies and re-visit current regulatory systems that physicians and patients rely on to ensure that health care AI is responsible, evidence-based, free from bias, and designed and deployed to promote equity. To develop actionable guidance for trustworthy AI in health care, the AMA reviewed literature on the challenges health care AI poses and reflected on existing guidance as a starting point for addressing those challenges (including models for regulating the introduction of innovative technologies into clinical care).

scholarly journals Prevalence of diabetes mellitus in rural population of Mullana, district Ambala, Haryana, India

2018 ◽  
Vol 6 (4) ◽  
pp. 1248
Author(s):  
Nitesh Pradhan ◽  
Abhishek Sachdeva ◽  
Tushar Goel ◽  
Sahil Arora ◽  
Shekhar Barua
Keyword(s):  
Diabetes Mellitus ◽  
Health Care Providers ◽  
Rural Population ◽  
Age Groups ◽  
International Diabetes Federation ◽  
Developed Countries ◽  
Care Providers ◽  
High Prevalence ◽  
The World ◽  
Prevalence Of Diabetes Mellitus

Background: Diabetes mellitus (DM) is a major cause of avoidable blindness in developing and developed countries. The International Diabetes Federation (IDF)’s Diabetes Atlas reports that India has the highest number of people with diabetes (nearly 25%) in the world, and hence considered to be the “Diabetes Capital of the World”.Methods: This is a hospital record based study was planned to estimate the prevalence of Diabetes Mellitus in various age groups in rural population of Mullana, District Ambala(Haryana).Results: Out of 1050 patients screened 50 were found to be having Diabetes mellitus (DM) 1000 were non-diabetic i.e. prevalence of Diabetes mellitus (DM) was found to be 4.76%. Out of 362 males screened 22 were suffering from Diabetes mellitus (DM) i.e. prevalence of 6.07%. Whereas out of 688 females screened 28 were suffering from Diabetes mellitus (DM) i.e. prevalence of 4.06%. Prevalence of Diabetes mellitus (DM) in males was found to be maximum in age group of more than 70 years i.e. 6.97% as compare to female i.e.5.29%.Conclusions: Thus, the current study recorded high prevalence of Diabetes mellitus (DM) among rural population which should be a cause of concern for health care providers. 

The risk of bleeding with anticoagulant treatments

Phlebologie ◽  
2011 ◽  
Vol 40 (04) ◽  
pp. 203-209 ◽  
Author(s):  
G. Palareti
Keyword(s):  
Health Care Providers ◽  
Significant Proportion ◽  
New Drugs ◽  
Phase Iii ◽  
Limiting Factors ◽  
Clinical Indication ◽  
Individual Risk ◽  
Anticoagulant Treatment ◽  
Care Providers ◽  
Risk Of Bleeding

SummaryAnticoagulant treatments are given to prevent and/or treat thrombotic complications in many clinical conditions, including atrial fibrillation (the most frequent indication for anticoagulant treatment), venous thromboembolism, acute coronary syndromes and after invasive cardiac procedures. Anticoagulation with vitamin K antagonists (VKAs) is currently almost the unique kind of therapy for chronic anticoagulation. It is highly effective in the prevention or treatment of thrombotic events but it is associated with a non negligible risk of bleeding, that is the most important complication of this therapy and a major concern for both physicians and patients. The risk of bleeding and the difficulties for the patients and health care providers associated with the necessary correct management of this treatment are limiting factors for a more widespread prescription of the treatment, leaving without an effective therapy a significant proportion of patients who would have a clear clinical indication for chronic anticoagulation. This review analyses the treatment- and person-associated risk factors for bleeding during VKAs and the tools that have been proposed to assess the individual risk of bleeding. New oral anticoagulant drugs seem to overcome at least some of the limitations of VKAs. Potentially, they can allow a less demanding and more stable anticoagulant treatment, with less side-effects allowing that more patients can receive an appropriate anticoagulant treatment. Based on the so far available phase III clinical studies, it is possible to assume that also these new drugs are associated with a risk of bleeding, that is probably related to the intensity of treatment.

scholarly journals Decrease in (Major) Amputations in Diabetics: A Secondary Data Analysis by AOK Rheinland/Hamburg

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Melanie May ◽  
Sebastian Hahn ◽  
Claudia Tonn ◽  
Gerald Engels ◽  
Dirk Hochlenert
Keyword(s):  
Health Care Providers ◽  
Secondary Data ◽  
Management Program ◽  
Medical Community ◽  
Insurance Company ◽  
Care Providers ◽  
Integrate Health Care ◽  
Before And After ◽  
Specialized Care ◽  
Log Linear

Aim. In two German regions with 11.1 million inhabitants, 6 networks for specialized treatment of DFS were implemented until 2008. Data provided for accounting purposes was analysed in order to determine changes in the rate of diabetics requiring amputations in the years before and after the implementation.Method. Data covering 2.9 million people insured by the largest insurance company between 2007 and 2013 was analysed by the use of log-linear Poisson regression adjusted for age, gender and region.Results. The rate of diabetics needing major amputations fell significantly by 9.5% per year (p<0.0001) from 217 to 126 of 100,000 patients per year. The rate of diabetics needing amputations of any kind fell from 504 to 419 of 100,000 patients per year (p=0.0038).Discussion. The networks integrate health care providers in an organised system of shared care. They educate members of the medical community and the general public. At the same time, a more general disease management program for people with diabetes was implemented, which may also have contributed to this decrease. At the end of the observation period, the rate of diabetics requiring amputations was still high. For this reason, further expansion of organised specialized care is urgently needed.

scholarly journals Presentation of menopausal symptoms: A village based community study

2014 ◽  
Vol 6 (1) ◽  
pp. 87-90 ◽  
Author(s):  
Mona Srivastava ◽  
Ritu Srivastava ◽  
Balram Pandit
Keyword(s):  
Health Care Providers ◽  
Rural Women ◽  
Rating Scale ◽  
Age Groups ◽  
Cross Sectional Study ◽  
Menopausal Symptoms ◽  
Care Providers ◽  
Medical Sciences ◽  
Natural Menopause ◽  
Cross Sectional

Background: The present observational, cross sectional study was carried out in rural women (n=117) from the Varanasi area with natural menopause to evaluate menopausal symptoms in women above the age of 40, as well as to evaluate the correlation of age on these symptoms. Materials and Methods: A crossectional assessment by interviewing regarding the menopausal complaints in the following 40-44(n=27), 45- 50(n=30) and above 50 (n =60) years age groups. Menstrual rating scale (MRS) was administered to all the women forming the sample. Results: Mean age at menopause was 47.35 years. Mean number of menopausal symptoms in three age groups were as (mean±SD)10.53±7.33, 7.70± 6.76 and14.50±10.77 respectively, which varied significantly (F=4.86, df=2, 87, P=0.009). The study reveal, varying nature of symptoms with age and MDSM (Mean Duration since Menopause), with vasomotor symptoms being more prevalent with lesser MDSM and psychological and rheumatic complaints more prevalent with increasing age and MDSM in this region. Conclusion: Such regional studies will help to corroborate data so that health care providers can plan strategies for the middle aged women suffering from these menopausal symptoms. DOI: http://dx.doi.org/10.3126/ajms.v6i1.8431 Asian Journal of Medical Sciences Vol.6(1) 2015 87-90

Characteristics of Nurse Practitioner Practice in Family Health Teams in Ontario, Canada

2018 ◽  
Vol 19 (3-4) ◽  
pp. 72-81 ◽  
Author(s):  
Roberta Heale ◽  
Simone Dahrouge ◽  
Sharon Johnston ◽  
Joan E. Tranmer
Keyword(s):  
Health Care Providers ◽  
Nurse Practitioners ◽  
Age Groups ◽  
Family Health ◽  
Physician Service ◽  
Full Potential ◽  
Diagnostic Code ◽  
Care Providers ◽  
Cross Sectional ◽  
The Individual

Nurse practitioners (NPs) in Ontario work in a number of settings, including physician-led, interprofessional Family Health Teams (FHTs). However, many aspects of NP practice within the FHTs are unknown. Our study aimed to describe the characteristics of NP practice in FHTs and the relationships between NPs and physicians within this model. This cross-sectional descriptive study analyzed NP service and diagnostic code data collected for every NP patient encounter from 2012 to 2015. Encounter data were linked to health administrative data housed at the Institute for Clinical Evaluative Sciences to allow for comparison with physician service and diagnostic codes. Findings demonstrated that NPs saw patients across all age groups for one to more than five problems per encounter and that NPs handled both acute and episodic care and chronic disease management issues. Patients with chronic conditions had more encounters with physicians than with NPs. In addition, compared to physicians, NPs saw more female than male patients. Our findings provide a snapshot of NP practice in FHTs and may be useful in informing other practice models in Ontario, elsewhere in Canada, and internationally. More evidence is needed, however, to clarify the responsibilities of the NPs in collaborative relationships with physicians and to embed policies that will ensure that NPs work to their full potential. In addition, applying service coding to all health care providers in FHTs could enhance data on interprofessional teams and the individual clinicians that comprise them.

Mandatory Vaccination

2021 ◽  
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Age Groups ◽  
Mass Vaccination ◽  
Vaccine Uptake ◽  
Childhood Vaccination ◽  
Vaccine Hesitancy ◽  
Care Providers ◽  
Vaccination Programs ◽  
Mandatory Vaccination

Across the world, mass vaccination programs run by governments or third-sector organizations have saved countless lives; minimized human suffering; and maintained economic, social, and cultural functioning. Vaccination programs predominantly focus on diseases that once ravaged the infant and early childhood years. However, with significant global variation, vaccination programs also exist for adolescents, pregnant women, new parents, the elderly, and people with comorbidities as well as catch-up or booster programs for particular age groups or vaccines. Governments and organizations also run annual influenza vaccination programs for entire populations or key workers, and health-care and education workers may be subject to additional vaccination requirements. The commonality of all mass vaccination programs is that the state adopts a key role in planning, coordinating, and funding them, or implementing mechanisms to ensure vaccines’ receipt by populations. The state’s role makes mandatory vaccination a possibility. Numerous scholarship forms the evidence base for the safety, efficacy, and necessity of vaccines. However, vaccination as a practice has consistently been accompanied by a minority who doubt and refuse, either for some or all vaccines. Concern about refusal has grown in recent years. An extensive Oxford Bibliographies article, “Vaccine Hesitancy,” explains why doubt and refusal develop and persist, how scholars make sense of it, and how governments and health-care providers can address it. However, hesitancy is not the only determinant of suboptimal vaccine uptake. Vaccination programs can also fail to reach populations due to insufficient generation of demand, inefficient or inappropriate service provision, cost barriers, and access barriers. Understanding the determinants of undervaccination in any given region, country, or population group will be essential to determining what strategies, including mandatory vaccination, are appropriate. Mandatory vaccination is just one strategy among a suite of tools that governments and organizations can employ to increase uptake of vaccines by particular cohorts. Mandatory vaccination is receiving current attention due to governments in several high-income jurisdictions recently utilizing it to address parents’ vaccine hesitancy. However, as the scholarship in this article illuminates, many jurisdictions’ mandatory childhood vaccination policies predate current concerns around hesitancy. Mandates have long performed key roles in the governance of vaccination uptake, including in contexts where attention to other programmatic aspects or health promotion practices may be lacking. The author would like to acknowledge the assistance of Amy Morris in the writing of the Mandatory Vaccination of Health-Care Workers—Policies, Experiences, and Impact and the Mandatory Vaccination—Attitudinal Studies sections of this article.

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