Sessió Paps Neo Mama Gener05
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- The next few slides will provide information about the Guide to Community Preventive Services project.Following this will be an overview of the Community Guide chapter on tobacco prevention and control followed by detail about the first 15 strategies for which the Task Force has issued recommendations for use. Then, we’ll take a look in a little more depth at the bodies of evidence evaluating the effectiveness of smoking bans and restrictions, reminder systems used to prompt health care providers to address smoking in their patient interactions. We’ll look at our most recent review, the evidence regarding the constellation of interventions implemented with the intent of reducing or restricting access to tobacco products by minors.Finally will be a preview of the reviews that we are currently working on regarding school-based interventions.
- Tobacco use is the single largest cause of preventable premature mortality in the United States. It also represents an enormous cost burden to the nation. The question is, what works to make tobacco use prevention and control at the population or community level? The Guide to Community Preventive Services addresses the effectiveness of community-based interventions for three strategies to promote tobacco use prevention and control: 1) prevent tobacco product use initiation, 2) increase cessation and 3) reduce exposure to environmental tobacco smoke (ETS). The findings strengthen and complement existing guidelines (hyperlink table and text to existing guidelines) on tobacco prevention and control.
- The next few slides will provide information about the Guide to Community Preventive Services project.Following this will be an overview of the Community Guide chapter on tobacco prevention and control followed by detail about the first 15 strategies for which the Task Force has issued recommendations for use. Then, we’ll take a look in a little more depth at the bodies of evidence evaluating the effectiveness of smoking bans and restrictions, reminder systems used to prompt health care providers to address smoking in their patient interactions. We’ll look at our most recent review, the evidence regarding the constellation of interventions implemented with the intent of reducing or restricting access to tobacco products by minors.Finally will be a preview of the reviews that we are currently working on regarding school-based interventions.
- The Guide to Community Preventive Services, or Community Guide for short, is the work of a Task Force of 15 national experts in public health and health care delivery. Tommy Thompson of Group Health is one member of this task force that you might know. The Task Force was formed in 1996 to direct series of reviews of the literature which the Task Force would review and issue recommendations regarding use. The idea is that Task Force recommendations would be useful to communities and to health care systems in choosing and implementing effective interventions for a variety of health issues..not just tobacco, but also topics such as motor vehicle occupant injuries, diabetes management, physical activity, and a lot more.The Community Guide is also a process, a set of methods for conducting systematic reviews of the literature including assessments of study quality and summaries of outcomes in a format that would save time for decision-makers in reviewing the literature.The end result of our work is an ever expanding set of evidence reviews and evidence r-based recommendations As of August 2002, 77 findings across 7 topic areas have been published. Presently, these reviews and recommendations are published by topic, but we’re in the process of putting them in a book
- Each chapter follows a standard method for development and evaluation. The development process in a nutshell is as follows:Each chapter begins with the recruitment of a team of consultants providing expertise from national, regional, and local programs, but implementers and evaluators. These experts help to develop the conceptual approach to the chapter, identifying across these very wide subjects, the areas to focus on, and areas that we exclude.Within the focus areas, this team generates a complete list of potential interventions, and then establishes a priority order for inclusion in the chapter. In this effort the team attempts to identify commonly implemented interventions, under-implemented interventions that might be effective, and over-implemented interventions that might not be effective.From this priority list, the Guide staff initiates a systematic search for published evidence from comparative studies. Every identified study undergoes a standardized abstraction and evaluation process. This process includes a duel rating system for suitability of the study design, and a nine point quality of execution checklist.From the studies which meant our design and execution requirements we then summarize the evidence on effectiveness, the information on applicability, other benefits, potential harms and economic information.The Task Force then reviews all of this information and issues a recommendation on use for each intervention evaluated.
- Turning now to the Community Guide chapter on Tobacco. To date we’ve involved about 20 national and regional experts in tobacco prevention and control in our reviews. These experts started with a list of 92 possible strategies, which we compressed and then selected a priority list of 10 intervention categories to review.Our systematic review started with screening about 16,000 titles and abstracts. We read about 1300 papers and formally reviewed about 350 of them which we identified as studies. These studies provided evidence on effectiveness of 15 more specific intervention strategies. We summarized this evidence and provided it to the Task Force for review.
- Tobacco use is the single largest cause of preventable premature mortality in the United States. It also represents an enormous cost burden to the nation. The question is, what works to make tobacco use prevention and control at the population or community level? The Guide to Community Preventive Services addresses the effectiveness of community-based interventions for three strategies to promote tobacco use prevention and control: 1) prevent tobacco product use initiation, 2) increase cessation and 3) reduce exposure to environmental tobacco smoke (ETS). The findings strengthen and complement existing guidelines (hyperlink table and text to existing guidelines) on tobacco prevention and control.
- Each chapter follows a standard method for development and evaluation. The development process in a nutshell is as follows:Each chapter begins with the recruitment of a team of consultants providing expertise from national, regional, and local programs, but implementers and evaluators. These experts help to develop the conceptual approach to the chapter, identifying across these very wide subjects, the areas to focus on, and areas that we exclude.Within the focus areas, this team generates a complete list of potential interventions, and then establishes a priority order for inclusion in the chapter. In this effort the team attempts to identify commonly implemented interventions, under-implemented interventions that might be effective, and over-implemented interventions that might not be effective.From this priority list, the Guide staff initiates a systematic search for published evidence from comparative studies. Every identified study undergoes a standardized abstraction and evaluation process. This process includes a duel rating system for suitability of the study design, and a nine point quality of execution checklist.From the studies which meant our design and execution requirements we then summarize the evidence on effectiveness, the information on applicability, other benefits, potential harms and economic information.The Task Force then reviews all of this information and issues a recommendation on use for each intervention evaluated.
- Each chapter follows a standard method for development and evaluation. The development process in a nutshell is as follows:Each chapter begins with the recruitment of a team of consultants providing expertise from national, regional, and local programs, but implementers and evaluators. These experts help to develop the conceptual approach to the chapter, identifying across these very wide subjects, the areas to focus on, and areas that we exclude.Within the focus areas, this team generates a complete list of potential interventions, and then establishes a priority order for inclusion in the chapter. In this effort the team attempts to identify commonly implemented interventions, under-implemented interventions that might be effective, and over-implemented interventions that might not be effective.From this priority list, the Guide staff initiates a systematic search for published evidence from comparative studies. Every identified study undergoes a standardized abstraction and evaluation process. This process includes a duel rating system for suitability of the study design, and a nine point quality of execution checklist.From the studies which meant our design and execution requirements we then summarize the evidence on effectiveness, the information on applicability, other benefits, potential harms and economic information.The Task Force then reviews all of this information and issues a recommendation on use for each intervention evaluated.
- Tobacco use is the single largest cause of preventable premature mortality in the United States. It also represents an enormous cost burden to the nation. The question is, what works to make tobacco use prevention and control at the population or community level? The Guide to Community Preventive Services addresses the effectiveness of community-based interventions for three strategies to promote tobacco use prevention and control: 1) prevent tobacco product use initiation, 2) increase cessation and 3) reduce exposure to environmental tobacco smoke (ETS). The findings strengthen and complement existing guidelines (hyperlink table and text to existing guidelines) on tobacco prevention and control.
- The Guide to Community Preventive Services, or Community Guide for short, is the work of a Task Force of 15 national experts in public health and health care delivery. Tommy Thompson of Group Health is one member of this task force that you might know. The Task Force was formed in 1996 to direct series of reviews of the literature which the Task Force would review and issue recommendations regarding use. The idea is that Task Force recommendations would be useful to communities and to health care systems in choosing and implementing effective interventions for a variety of health issues..not just tobacco, but also topics such as motor vehicle occupant injuries, diabetes management, physical activity, and a lot more.The Community Guide is also a process, a set of methods for conducting systematic reviews of the literature including assessments of study quality and summaries of outcomes in a format that would save time for decision-makers in reviewing the literature.The end result of our work is an ever expanding set of evidence reviews and evidence r-based recommendations As of August 2002, 77 findings across 7 topic areas have been published. Presently, these reviews and recommendations are published by topic, but we’re in the process of putting them in a book
- The Guide to Community Preventive Services, or Community Guide for short, is the work of a Task Force of 15 national experts in public health and health care delivery. Tommy Thompson of Group Health is one member of this task force that you might know. The Task Force was formed in 1996 to direct series of reviews of the literature which the Task Force would review and issue recommendations regarding use. The idea is that Task Force recommendations would be useful to communities and to health care systems in choosing and implementing effective interventions for a variety of health issues..not just tobacco, but also topics such as motor vehicle occupant injuries, diabetes management, physical activity, and a lot more.The Community Guide is also a process, a set of methods for conducting systematic reviews of the literature including assessments of study quality and summaries of outcomes in a format that would save time for decision-makers in reviewing the literature.The end result of our work is an ever expanding set of evidence reviews and evidence r-based recommendations As of August 2002, 77 findings across 7 topic areas have been published. Presently, these reviews and recommendations are published by topic, but we’re in the process of putting them in a book
- Tobacco use is the single largest cause of preventable premature mortality in the United States. It also represents an enormous cost burden to the nation. The question is, what works to make tobacco use prevention and control at the population or community level? The Guide to Community Preventive Services addresses the effectiveness of community-based interventions for three strategies to promote tobacco use prevention and control: 1) prevent tobacco product use initiation, 2) increase cessation and 3) reduce exposure to environmental tobacco smoke (ETS). The findings strengthen and complement existing guidelines (hyperlink table and text to existing guidelines) on tobacco prevention and control.
Presentation Transcript
- Slide 1: RESUM DE LA SESSIÓ 1. Cribratge N. mama. 2. Tinció VPH amb àc. Acètic. 3. Taula risc C-V REGICOR. 4. Document de Voluntats Anticipades. 5. Valoració PAPPS 2005- Plans Personals EAP-Vic
- Slide 2: Cribratge de la Neo MAMA Recomenacions segons les reunions CAP Osona 2004-2005 Marta Cantero Teresa Masat Joan Carrera Mercès Tordera Rosa Banús Jordi Casanovas Raimon Rovira Eulàlia Fierro Albert Planes Anna Fusté M.José Martinez
- Slide 3: Introducció El Cancer + freq en dones occidentals Una de les causes de mort + imp en dones de mitjana edat. 12 % de reducció mortalitat anual si Cribratge 50-64à 15% reducció anual mortalitat si cribratge 50-69à.
- Slide 4: Programa detecció precoç a Osona Totes les dones 50-64à, però se seguiran fins als 69à Detectades segons registres censals, citades personalment Ratificades I consensuades pels CAPs. Mx doble projecció / 2à Doble interpretació Enviament de resultats a pacient + metge de capçalera
- Slide 5: Conclusions del grup Respectar dinàmica del programa poblacional de cribratge. Assegurar des del CAP el cribratge si anteced. 1r grau N.mama (iniciar cribratge 10 anys abans del Dx a la familiar). Fer Mx / any fins que entrin al programa general. Registre sistemàtic de Mx a la HCAP informatitzada (metge, inf, llev.)
- Slide 6: Conclusions del grup Si la senyora demanda per patologia: visita pel capçalera I que ell valori les exploracions No derivar CAP Osona x Ecos mama (HGV o Clínica de Vic), per assegurar PAAF si sospita. – Indic.ECO: • <30à + bulto: si PAAF benigne, STOP controls. • >30à amb Mx recent Normal I bulto. Què passa en dones 40-50à que el Gine aconsella Mx I citen per llevadora? Les ha de re-citar a capçalera I que ell decideixi segons criteri clínic.
- Slide 7: Tinció àc. Acètic x VPH.
- Slide 8: Tinció àcid acètic. LÍQUID: Dilució d’àc. Acètic al 5 % (ò ac. Acètil glacial al 5%) PROPIETATS: detecció de lesions no visibles a gland / prepuci (possibilitat de reinfeccions a dones amb el VPH)
- Slide 9: Tinció àcid acètic. METODOLOGIA – Remullar la zona amb gassa xopa amb àc. Acètic (està al magatzem) durant 5 minuts. – Mirar amb làmpada-lupa o a simple vista. – Les lesions semi-ocultes suggestives de VPH agafaran una tinció blanquinosa. – Cauteritzar les lesions amb Nitrogen / Imiquod. – Nou control en 2-3 setmanes.
- Slide 10: Taules REGICOR
- Slide 11: Estudis REGICOR Adaptació de les taules Framingham de risc C-V a la població catalana REGICOR (Registre de Girona de malalaties del COR). http://www.regicor.org/default.htm Validació amb les dades estudi VERIFICA. Permeten fer estimació de risc d’event coronari en 10 anys S’aconsella punt de tall de 10% per decidir si Hipolipemiants El GERCO I el SISO adoptaran aquest sistema pel càlcul de risc CV
- Slide 12: Proposta d’adaptació Canviar criteris risc CV Framingham pels del REGICOR. Quan toqui calcular el risc CV fer-ho directament a través del càlcul del REGICOR (que permet la nova versió d’OMI) i guardar aquest valor com a DGP. Considerar alt Risc CV una puntuació >10% al REGICOR.
- Slide 13: DVA (Document de Voluntats Anticipades) Testament Vital ( llegiu l’article, penseu dubtes i … to be continued )
- Slide 14: PAPPS 2005 i LLIBRE BLANC D’ACTIVITATS PREVENTIVES (i relació respecte els PLANS PERSONALS OMI actuals) Són les activitats PAPPS que recomana també el SISO.
- Slide 15: HTA <14 anys: 1 medició 14-40 anys: 1 determinació cada 4 anys >40 anys (sense límit): 1 determinació cada 2 anys PLA PERSONAL EAP-VIC: De 15 a 99 anys cada 2 anys (ho canviem?)
- Slide 16: Hipercolesterolèmia Homes <35à i Dones <45à: 1 determ. Homes 35-75à i Dones 45-75à: 1 determinació cada 5 anys Homes i dones >75à : 1 determinació (si no en tenen cap de prèvia) PLA PERSONAL EAP-VIC: Homes i dones de 25 a 70 anys: 1 determinació cada 4 anys (ho canviem?)
- Slide 17: DIABETES NO hi ha evidències per cribratge sistemàtic PLA PERSONAL EAP-VIC (perquè ens ho demanava Cat Salut): Persones de 45-80 anys: 1 glicèmia venosa cada 5à Persones 15-99à amb factors de risc DM (AF, macrosomes, intolerància a glucosa, obesitat, etc): 1 glicèmia cada 1à
- Slide 18: Activitat física >14 anys (sense límit): Preguntar sobre activitat física no més sovint de cada 3 mesos i no menys sovint de cada 2 anys. PLA PERSONAL EAP-VIC: De 15 a 80 anys: cada 3 anys.
- Slide 19: Obesitat Dels 15 a 20 à: Tenir almenys 1 mesura de pes, talla i IMC. >20 anys (sense límit): Mesura de pes, talla i IMC cada 4 anys. PLA PERSONAL EAP-VIC: Dels 15 als 99 anys : cada 2 anys.
- Slide 20: Prevenció Tabaquisme Persones >10 anys (sense límit d’edat): Cribratge i registre cada 2 anys. Si >25 anys i mai han fumat: NO cal cribratge Exfumadors (>1 any): cada 2 anys. PLA PERSONAL EAP-VIC: Homes i dones de 15 a 80 anys: cribratge cada 2 anys
- Slide 21: Consum de risc d’ALCOHOL Persones >14à: cribratge i quantificació cada 2 anys. En adolescents potser es necessiti una freqüència més alta (però no especifiquen). PLA PERSONAL EAP-VIC: Dels 15 als 99 anys : cada 2 anys.
- Slide 22: Prevenció SIDA i altres MTS Població 14 a 35 anys: interrogatori sobre ús de preservatiu i educació en cas necessària cada 2 anys PLA PERSONAL EAP-VIC: (Ho tenim dins la PAPPs de planificació familiar): interroga cada 2 anys a la població de 14 a 45 anys sobre mètode anticonceptiu (s’hi pot afegir la recomenació de preservatiu).
- Slide 23: Prevenció TBC No està indicat el cribratge poblacional. Fer i llegir PPD (+ >5mm o >15mm si BCG prèvia), a: – VIH+ o conductes de risc (UDVP, prostitutes) – Contactes pròxims i repetits amb TBC bacil·lífera. – Immunodeprimits o en ttmt immunosupressor – Indigents. – Minories ètniques de baix nivell socio-econòmic. – Immigrants de països d’alta endemicitat. – Residents d’institucions tancades (presoners, ancians). – Professionals de risc de contagiar la resta (mestres, llars d’infants, sanitaris, etc.) PLA PERSONAL EAP-VIC: No tenim cap activitat associada
- Slide 24: Càncer de MAMA Dones 50 a 70à : MAMO cada 2 anys Coordinació amb programes de cribratge poblacional. PLA PERSONAL EAP-VIC: Dones 50-70à : cada 2 anys.
- Slide 25: Càncer de CÈRVIX Dones 25 a 65 anys: – 2 PAP inicial amb 1 any de diferència – Després 1 citologia cada 3-5 anys. Dones >65à (sense citologia darrers 5à): – 2 citologies en 1 any de diferència PLA PERSONAL EAP-VIC: EXCLUSSIÓ: Dones 25-35à: cada 3 anys Dones 36-50à: cada 5 anys. •Verges Dones 51 a 69à: cada 10 anys. •Histerectomia total.
- Slide 26: Càncer d’ENDOMETRI No hi ha evidències per cribratge sistemàtic en dones assimptomàtiques. PLA PERSONAL EAP-VIC: Dones 55 a 99 anys: almenys 1 cop.
- Slide 27: Càncer COLORECTAL Persones >50à: – Test de sang oculta en femta cada 1-2 anys, i/o – Sigmoidoscòpia cada 5 anys, o – Colonoscòpia cada 10 anys La seva aplicació al nostre mitjà precisa d’avaluació prèvia de cost-efectivitat i PLA PERSONAL EAP-VIC: recursos necessaris. No tenim cap activitat associada.
- Slide 28: Càncer de PRÒSTATA No hi ha evidència científica per aconsellar cribratge sistemàtic Els pacients que demanin PSA han de ser informats sobre els beneficis/riscs del cribratge i tractament. PLA PERSONAL EAP-VIC: No tenim cap activitat associada.
- Slide 29: Càncer de PELL NO hi ha evidència per recomenar el cribratge sistemàtic Evitar exposició solar excessiva i usar els protectors solars. Detectar persones de risc: – fototipus baixos, – nens, – UVAs, – xeroderma pigmentós, – AF melanoma o de nevus displàsics, – nevus congènit gegant. PLA PERSONAL EAP-VIC: No tenim cap activitat associada.
- Slide 30: CONCLUSIONS Ens apuntem com a centre adscrit al PAPPS? •Tindríem informació de les actualitzacions i dels criteris. • Tindríem informació periòdica de l’estat del PAPPs en altres centres sanitaris catalans i espanyols.
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