Hdr planning hot topics
Download
1 / 30

HDR PLANNING & HOT TOPICS - PowerPoint PPT Presentation


  • 166 Views
  • Uploaded on

HDR PLANNING & HOT TOPICS. Nov 3 rd 2010. This Afternoon. HDR Planning 14.00 – 15.15 Tea break 15.15 Hot topics 15.30 – 17.00. Planning. Hot Topics. Pub quiz style Split into 3 groups Question and answers Discussion Top team each round will win a prize. Aims.

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about ' HDR PLANNING & HOT TOPICS' - haley-oliver


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript

This afternoon
This Afternoon

  • HDR Planning 14.00 – 15.15

  • Tea break 15.15

  • Hot topics 15.30 – 17.00



Hot topics
Hot Topics

  • Pub quiz style

  • Split into 3 groups

  • Question and answers

  • Discussion

  • Top team each round will win a prize


Hdr planning hot topics
Aims

  • To consider the latest studies and how they influence our prescribing in relation to:

    - Aspirin

    - Glucosamine

  • To review the latest research into the use of PSA in screening for prostate cancer


1 aspirin
1) Aspirin

  • Who do you think needs to be prescribed aspirin?

    (as currently under debate....ignore diabetic patients, focus on those with cardiovascular risk)


Aspirin the study
Aspirin – the study

  • Lancet 2009: 373: 1849

  • Antithrombotic Trialists Collaboration (ATTC) meta analysis looked as use of aspirin in primary and secondary prevention.

  • A large study

  • All compared aspirin to placebo

  • The outcomes were CV events and the rate of harm


Primary prevention
Primary prevention

  • Aspirin DOES NOT reduce the CV MORTALITY

  • Aspirin DOES reduce CV EVENTS – but the risk reduction v small (NNT 1666)

  • HARMS for every 3333 treated over 12m there would be one additional GI/extra cranial bleed (NNH 3333)

  • DTB agree, current practice is recommended that:

    • Aspirin shouldn’t be started for primary prevention

    • In those already taking it – explain current evidence to patient.


Secondary prevention
Secondary Prevention

  • Aspirin prevents 1 CV event per year for every 66 people treated (NNT 66)

  • Aspirin prevents 1 vascular death for every 344 people treated

  • There was insufficient data to report on GI/extra-cranial bleeds or haemorrhagic CVAs

  • DTB

    • Secondary prevention 75mg aspirin/day

    • (no evidence of improved protection with increase dose – but increased dose does increase GI haemorrhage risks)


Aspirin questions and answers
Aspirin – Questions and Answers

  • Who do you think needs to be prescribed aspirin?

  • Not for primary prevention

  • Secondary prevention require 75mg OD

  • Secondary prevention would include those with TIA/stroke, previous MI, angina.


2 glucosamine
2) Glucosamine

  • Who should be prescribed glucosamine?

  • What advice should you give a patient when commencing treatment?

  • In which patients is the use of glucosamine contraindicated?


Glucosamine
Glucosamine

  • Glucosamine is only indicated in patients with knee OA (DTB 2008; 46:81-4)

  • NICE does not support the use of glucosamine in OA (NICE, 2008)


Derbyshire medicines management may 2010 advice
Derbyshire Medicines Management May 2010 Advice

  • A trial of glucosamine sulphate 1500mg once daily is recommended as a treatment option in patients suffering from osteoarthritis of the knee, after trying, or in conjunction with paracetamol.

  • Use may mean that potentially toxic NSAIDs or coxibs need not be used.

  • It may take several weeks for the full effect to be seen.

  • If prescribed generically – the community pharmacy chooses the brand to supply. Expensive brands cost up to £90 for a thirty day supply

  • Medicines Management recommends that glucosamine sulphate is prescribed as the brand Valupak. Thirty days supply of the 1500mg strength costs only £2.83.


What should we tell patients
What should we tell patients?

  • None of the clinical trails have shown glucosamine is particularly effective

  • It may reduced pain in some people

  • It probably won’t improve function

  • It’s unclear whether it has any long term effects (slowing disease progression)

  • Glucosamine in safe in most people – but there are CIs

  • Glucosamine may take several weeks to work – trial for 3 months, if pain is no better, consider stopping


Glucosamine questions and answers
Glucosamine - Questions and Answers

  • Who should be prescribed glucosamine?

  • Only those with knee OA

  • What advice should you give a patient when commencing treatment?

  • May improve pain, probably won’t improve function, long term effects unclear, if no improvement at 3 months – consider stopping

  • In which patients is the use of glucosamine contraindicated?

  • Pregnant, breast feeding, allergic to shellfish and those on warfarin


Psa testing questions
PSA Testing Questions

1) What percentage of men with a normal PSA have clinically significant prostatic cancer?

2) What percentage of men with raised PSA will not have prostate cancer?

3) List 3 advantages and 3 disadvantages of the PSA test


Hdr planning hot topics
PSA

  • PSA is a glycoprotein produced by the prostate

  • The amount produced can increase due to malignant and benign processes


Hdr planning hot topics
PSA

  • PSA has long been used in general practice.

  • There is currently lots of debate over whom should have a PSA test, there is no agreed criteria for testing.

  • But, questions to consider;

    • Could the PSA be a useful screening tool?

    • Would screening reduce mortality?


Bmj 2009 339 b3537
BMJ 2009;339:b3537

  • Looked specifically at how well PSA performs as a screening test depending on cut off values chosen.

  • The authors concluded that additional biomarkers would be needed before population screening should be introduced.


Systemic review of psa screening bmj 2010 34 c4543
Systemic review of PSA screening – BMJ 2010; 34:c4543

  • Systemic review of PSA screening – BMJ 2010; 34:c4543

  • Pooled results from 6 major PSA screening studies (inc. PLCO and ERSPC)

  • Meta-analysis of 387,286 men showed:

  • Screening increased your risk of being given a diagnosis of prostate cancer

  • Screening had no impact on death from prostate cancer or overall mortality


Plco screening trial nejm 2009 360 1310 0
PLCO Screening Trial (NEJM 2009; 360: 1310-0)

  • 76,000 men (aged 55-74) were randomised to usual care or annual screening for prostate cancer

  • 40-52% of the men in the control group had screening each year

  • Screening picked up more cancers than usual care

  • Mortality from prostate cancer was not reduced in those who had been screened

  • Screening did not appear to pick up earlier tumours (similar rates of all stages in control and screening group)


Erspc nejm 2009 360 1320 8
ERSPC (NEJM 2009; 360:1320-8)

  • RCT 180,000 men aged 50-74 in 7 European countries.

  • Randomised to “no screening” or to “PSA once every 4 years”

  • Twice as many cancers were diagnosed in the screening group compared to the control group

  • Those who had undergone screening were 20% less likely to die of prostate cancer

  • Benefit of screening only seen in those aged 55 or more, not in those 50-54

  • There was a significant rate of over diagnosis (detecting tumours that would never become clinically significant)


Erspc continued
ERSPC (continued)

  • 1410 men would need to be screened to prevent one death from prostate cancer

  • 48 additional cases of prostate cancer would need to be treated to prevent one death from prostate cancer.


Comparing erspc and pclo
Comparing ERSPC and PCLO

  • Different cut-off values for action (3ng/ml v 4ng/ml)

  • Study population selection

  • Improved prostate cancer treatment over the course of the PCLO trial

  • Follow up of PCLO may not have been long enough.


What do these trials mean to our practice
What do these trials mean to our practice?

  • National Screening Committee have recommended that a prostate cancer screening programme should not be introduced in the UK

  • Men who ask for a PSA should continue to be offered the full range of information to allow them to make an informed decision


Psa summary
PSA Summary

  • PSA test has significant failings

  • Screening MIGHT save lives, but we don’t know whether it actually does any good...which is a far more important question.

  • Treating men with clinically unimportant cancers exposed them to harm with no benefits

  • PSA should not be done routinely without discussing risks and benefits with the patient

  • A single PSA <1ng/ml in a man’s 60s largely rules out the risk of clinically significant prostate cancer.


Psa answers 1
PSA Answers (1)

1) What percentage of men with a normal PSA have clinically significant prostatic cancer?

  • 20%

    2) What percentage of men with raised PSA will not have prostate cancer?

  • 66%


Psa answers 2
PSA Answers (2)

3) List 3 advantages and 3 disadvantages of the PSA test

  • Advantages

  • Reassurance if result is normal

  • May indicate cancer before symptoms present

  • May find cancer at an early stage

  • If treated may avoid worse outcomes, e.g. death

  • Even if aggressive/advance cancer, treatment may prolong survival

  • Disadvantages

  • False negatives

  • May have unnecessary tests and anxiety

  • Cannot differentiate slowly growing ‘v’ aggressive cancers

  • May cause unnecessary anxiety if it’s a slow, clinically insignificant ca

  • 48 men will undergo treatment to save one life


The end
The End

  • Questions?