分论坛二基层卫生与社区交流基于循证医学的老年人健康体检

1、基于循证医学的老年人吴华市宝安区医院（）市卫生计生能力建设和继续教育中心社区居民老王的体检需求 65岁，退休； 平素体健，无特殊不适； 高血压6年，规律治疗，好，未发现其他疾病； 抽烟20余年，现1包/2-3天，偶尔饮酒； 父亲有高血压病、心梗病史，母亲高血压； 肿瘤疾病史；无老王的周期性 生活 体格检查。 辅助检查：健康状况评估Ø 血常规、尿常规、Ø 肝功能（血清谷草转氨酶、血清Ø 肾功能（血清肌酐和血尿素）Ø 空腹血糖Ø 血脂（Tc、TG、LDL、HDL）Ø 心电图Ø 腹部 B 超（肝胆胰脾）转氨酶和总胆红素）补充项目主

2、要内容定义现状和问题基于循证医学的老年ppp主要内容定义现状和问题基于循证医学的老年ppp定义是指通过医学和方法对受检者进行身体检查，了解受检者健康状况、早期发现疾病线索和健康隐患的诊疗行为，用于和群体健康状况评价与疾病风险、及早期筛查的一种医学行为、方法与过程 。问题 重视和辅助检查，轻视病史和体格检查1959年与2000年诊断正确率比较年代1959年2000年漏诊率24%41%误诊率7%15%问题 忽略重要的功能评估Ø 生活方式Ø 心理健康Ø 认知功能Ø 跌倒风险Ø心风险问题 体检套餐化，套餐划分缺乏科学依据问题 报告解读过度依赖数据，数据

3、不严谨问题 体检后的健康管理缺乏持续性主要内容定义现状和问题基于循证医学的老年ppp循证医学（Evidence Based Medicine）基于循证医学的！老王的体检需求老王的体检需求-EBM Patient：高血压，血压好，无其他心脑症状 Intervention：颈动脉狭窄的筛查 Comaprison：查 Outcome：延长生存期EBM：医学实践的步骤1. 确定临床实践中的问题2. 检索有关医学文献3. 严格评价文献4. 应用最佳证据，指导临床决策5. 评估1-4项的效果和效率，不断改进临床关注的问题与没有进行筛查的人群相比，进行颈动脉超声检查的高血压命吗？会延长寿评估适用于老王的证据

4、Jonas DE, Feltner C, AHR,. Screening for asymptomatic carotid arterystenosis: A systematic review and meta-analysis for the US Preventive Services Task Force. Ann Intern Med 2014;161(5):33646.Abbott AL. Medical (nonsurgical) intervention alone is now best for prevention of stroke associated with asy

5、mptomatic severe carotid stenosis: Results of a systematic review and analysis. Stroke 2009;40(10):e57383.Abbott AL, Paraskevas KI, Kakkos SK,. Systematic review of guidelines forthe management of asymptomatic and symptomatic carotid stenosis. Stroke 2015;46(11):3288 301.Abbott AL, Adelman MA, Alexa

6、ndrov AV,. Why calls for more routinecarotid stenting are currently inappropriate: An international, multispecialty, expert review and position statement. Stroke 2013;44(4):118690.Abbott A. Critical issues that need to be addressed to improve outcomes for patients with carotid stenosis. Angiology 20

7、16;67(5):42026.Abbott AL, Nicolaides AN. Improving outcomes in patients with carotid stenosis: Call for better research opportunities and standards. Stroke 2015;46(1):78.结论 目前没有证据表明这项检查给带来好处，但有该检查给带来的证据，包括明显的手术和成本； 目前的证据不能做出可靠的分层，不足以特异性的识别出可以受益动脉内膜剥离术（CEA）的； 不能据此推荐给做颈动脉支架植入术，因为与CEA相比，颈动脉支架植入术将造成高出两倍

8、的中风或。（榜样）！U.S. Preventive Services Task FourceCarotid Artery Stenosis: ScreeningUSPSTF Release Date: July 2014Thyroid Cancer: ScreeningRelease Date: May 2017Chronic Obstructive Pulmonary Disease: ScreeningRelease Date: April 2016Pancreatic Cancer: ScreeningRelease Date: February 2004Cardiovascular D

9、isease Risk: Screening With ElectrocardiographyRelease Date: June 2018Cardiovascular Disease: Risk Assessment With Nontraditional Risk FactorsRelease Date: July 2018Celiac Disease: ScreeningRelease Date: March 2017Cognitive Impairment in Older Adults: ScreeningRelease Date: March 2014Hearing Loss in

10、 Older Adults:ScreeningRelease Date: August 2012Peripheral Artery Disease and Cardiovascular Disease: Screening and Risk Assessment With the ABIRelease Date: July 2018Skin Cancer: ScreeningRelease Date: July 2016Vitamin D Deficiency: ScreeningRelease Date: November 2014Impaired Visual Acuity in Olde

11、r Adults: ScreeningRelease Date: March 2016PSA-based screening for prostate cancerMen ages 5569For men aged 55 to 69 years, the decision to undergo periodic prostate-specific antigen (PSA)based screening for prostate cancer should be an individual one. Before deciding whether to be screened,men shou

12、ld have an opportuto discuss the potential benefits andharms of screening with their clinician and to incorporate their values and preferences in the decision.C RecommendationMen age 70 and olderThe USPSTF recommends against PSA-based screening for prostate cancer in men age 70 years and older.D Rec

13、ommendationDepression in Adults: ScreeningRelease Date: January 2016Abnormal Blood Glucose and Type 2 DM: ScreeningRelease Date: October 2015Abdominal Aortic Aneurysm: ScreeningRelease Date: June 2014High Blood Pressure in Adults: ScreeningRelease Date: October 2015Lung Cancer: ScreeningRelease Date

14、: December 2013Osteoporosis to PreventFractures: ScreeningRelease Date: June 2018Colorectal Cancer: ScreeningRelease Date: June 2016Obesity in Adults: Screening andManagementRelease Date: June 20122014基本项目共识续表续表居民老王的健康状况、65岁 平素体健，无特殊不适性高血压病6年 抽烟，偶尔饮酒，； 家庭条件较好； 早发CVD史 PE：BMI29.2kg/m2、BP130/82mmHg 心肺腹无异常居民老王推荐项目 生活 体格检查健康状况评估 跌倒筛查 日常生活活动和家庭评估 视力和损伤评估 评估吸烟的状态、尼古丁的依赖性和戒烟的 超重和肥胖的评估 运动和体力活动评估 缺血性心病(ICVD)10年发病风险评估血压