Current Practice Guidelines in Primary Care, 2005 by Ralph Gonzales

By Ralph Gonzales

This e-book is the single pocket-sized compendium of the most up-tp-date medical perform instructions in fundamental care. It contains the 60 so much common/important directions for basic care clinicians.

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A recent RCT using finasteride for chemoprevention of prostate cancer showed a reduced incidence of cancer in the treatment group but a greater proportion of high-grade tumors. Therefore, this strategy is not recommended. (NEJM 2003;349) Describe potential benefits and known harms of screening with PSA and DRE, diagnosis, and treatment; listen to the patient’s concerns; and individualize the decision to screen. ACPM ACP 1998 Men aged > 50 1997 yearsa Source Comments Recommendations Organization Date Population in high-risk groups (2 or more affected first-degree relatives, blacks) should begin screening at age 40.

See Risk Factors, page 54) No No Any underlying disease, condition, or medication known to ↑ the risk of osteoporosis? (See Secondary Osteoporosis, page 55) Yes Risk factors present? (See Risk Factors, page 54) Yes • • • > 65 years old ? • • Yes No • Treatment: • Alendronate • Calcitonin • SERMs NOTE: Treatment without BMD Test No No Yes Yes Known vertebral fracture? Counsel on: – Calcium – Vitamin D – Exercise – Alcohol cessation – Tobacco cessation BMD optional BMD = bone mineral densitometry SD = standard deviation DXA = dual-energy x-ray absorptiometry SERM = selective estrogenreceptor modulator Is the patient willing to consider treatment?

B Screen asymptomatic patients (? ahajournals. org/cgi/content/full/ 97/5/501 1. In the Asymptomatic Carotid Atherosclerosis Study (ACAS), the actuarial 5-year risk of ipsilateral stroke, operative stroke, and death was ≅ 5% with CEA vs. 11% in the control group. 3%. (JAMA 1995;273:1421) In ACAS, the benefit of surgery was greater for men than women (reduction in risk 66% vs. 17%). 2. The cumulative cost-effectiveness of targeted screening and surgery for high-grade carotid artery stenosis is ~$43,000 per QALY.

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