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Tampilkan postingan dengan label scans. Tampilkan semua postingan
Tampilkan postingan dengan label scans. Tampilkan semua postingan

Minggu, 29 Januari 2012

Study: Many women can skip frequent bone scans

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AppId is over the quota
ATLANTA (AP) — New research could mean millions of older women can skip frequent screening tests for osteoporosis: If an initial bone scan shows no big problems, many can safely wait 15 years to have another one, the study suggests.

Government advisers and leading doctor groups urge osteoporosis screening, but no one has known how often that should happen. The findings offer the best information to date on that question, experts said.

"This is landmark, in the sense that it could allow us to move on to more precise guidelines," said Dr. Heidi Nelson, a researcher at the Oregon Health & Science University who is an expert on the topic.

At issues are bone mineral density tests, which usually are done through X-rays and cost around $250. It takes about 10 minutes and involves less radiation than what's emitted during a chest X-ray. Medicare pays for testing every two years.

The new study feeds concerns that the tests are done too often, at least for some women.

"It's an expenditure of time, it's exposure to radiation, and it's cost. And there's no reason to expose yourself to any risks if there's going to be no benefit," explained Dr. Virginia Moyer, who heads the U.S. Preventive Services Task Force, a government panel that issues testing guidelines.

The test measures how thick bones are in certain spots, usually focusing on the hip and lower spine. Doctors use it to gain early warning of osteoporosis, a bone-thinning disease that can be staved off with better diet and exercise and treated with bone-building drugs. Nearly half of all women older than 50 will break a bone because of osteoporosis, according to the National Osteoporosis Foundation.

The government task force recommends that all women over 65 get a scan. The panel also recommends testing for younger postmenopausal women who seem at higher risk for fractures. But the task force has not said how often follow-up tests should be done, just that a couple years between tests are needed.

There are no immediate plans to update the task force's advice for osteoporosis screenings, but the new study will be an important consideration when the panel acts again, Moyer said.

The new, government-funded research involves nearly 5,000 women aged 67 years and older in a national health study that began in the 1980s. None had osteoporosis at the outset.

The researchers looked at how the women did on bone density tests, and watched for who got osteoporosis and when. They were followed for 15 years.

Based on that, the researchers concluded that women with a healthy initial test could wait as long as 15 years before getting a second screening. But women deemed at moderate risk should get tested about every five years. And women at high risk should get tested more often, perhaps even annually.

The research, published in Thursday's New England Journal of Medicine, was led by Dr. Margaret Gourlay of the University of North Carolina. She worries that her findings might be misinterpreted and cause some women to wait longer than they should for their next test. She cited earlier research suggesting not enough women get the recommended initial scan.

The 15-year interval applies only to postmenopausal women judged to be at low risk for osteoporosis from the first screening, she noted, and perhaps fewer than half of U.S. women over 65 fall into that category.

But she said even for those women, other risk factors have to be considered: smoking, slim build, prior broken bones and taking medication that has an eroding effect on bones.

She also noted that osteoporosis becomes a greater risk in the oldest patients, so a woman with a moderate risk who is 85 or older might be better off getting tested every three years instead of every five.

___

Online:

New England Journal: http://www.nejm.org

Osteoporosis information: http://www.bones.nih.gov

Associated Press

Source AP



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Jumat, 30 September 2011

More scans urged for unborn twins

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28 September 2011 Last updated at 00:35 GMT By Helen Briggs Health editor, BBC News website Twin pregnancy at 32 weeks Twins in the womb at 32 weeks Women expecting twins or triplets should be offered closer monitoring, including extra scans, according to new NHS guidelines.

Health watchdog NICE has drawn up recommendations for antenatal care in multiple pregnancies, amid evidence standards vary in England and Wales.

Mothers-to-be should be referred to specialist teams and receive a minimum of six scans, says NICE.

Charities say the guidelines will give mothers reassurance about their care.

Multiple births are on the rise, due mainly to an increase in the number of couples having IVF. They now account for 3% of births.

Until now, there have been no clear guidelines for women expecting twins or triplets in England and Wales, leading to differences in care, including the number and timing of scans, planned delivery dates, and the use of measures, such as bed rest, to prevent early labour.

Dr Fergus Macbeth, director of the centre for clinical practice at The National Institute for Health and Clinical Excellence (NICE), said: "We know there is a real clinical need for this guideline because NHS antenatal care for women expecting twins or triplets appears to vary considerably across England and Wales.

"For example, not all women with multiple pregnancies are cared for in dedicated settings such as 'twin clinics' or by multidisciplinary teams of healthcare professionals.

"This can lead to higher than necessary rates of assisted birth and Caesarean sections and also means that women are not appropriately assessed for possible risks during pregnancy.

"Although many women will have a normal pregnancy and birth, it is well known that there are higher risks involved for these types of pregnancy and so it is important to get it right."

Multi-disciplinary approach

The guidance says women expecting twins or triplets should receive at least six scans, and sometimes as many as 11.

A scan should be carried out at between 11 and 14 weeks to assess whether twins share a placenta, which can increase the risk of complications.

NICE said women at risk of going into labour early should not be routinely offered bed rest or drugs to prevent labour as there was no evidence that they work.

Continue reading the main story The risk of stillbirth or having a premature birth is higher in multiple pregnanciesSome risks are associated particularly with babies sharing a placentaSlow growth in the womb and congenital abnormalities are also more commonSource: NICEIn addition, the guidelines provide recommendations on when a planned birth should be offered.

They do not look at women who are pregnant with four or more babies.

Dr Virginia Beckett, from the Royal College of Obstetricians and Gynaecologists, welcomed the guidelines. She said increased monitoring and contact with healthcare workers would help ensure the mother and their babies received the best care possible.

"A multi-disciplinary approach including input from midwives, obstetricians and ultrasonographers will help ensure any complications are picked up early," she said.

Jane Denton, director of the Multiple Births Foundation, said: "Although much of the care at present is very good, there are many inconsistencies and often poor co-ordination between healthcare professionals if mothers are referred to other hospitals.

"These recommendations address all of these concerns and will give mothers confidence that they are receiving the highest standard of care, appropriate to their individual needs."



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