The American journal of the medical sciences
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Breast and gynecological cancers affect almost 900,000 women and therefore most health care providers will be involved at some point in the management of women with cancer. As the prognosis of all cancers is much more favorable when diagnosed in early stages, it is imperative that all health care providers are familiar not only with current screening guidelines for the average population, but also with the identification of high risk individuals who may benefit from more intense screening as well as available interventions to prevent disease or decrease risk. The purpose of this review article is to provide relevant information to physicians and other health care providers to aid in identifying patients that are classified as "high risk" for developing breast or a gynecologic cancer, outlining what interventions exist for adequate screening and risk reduction strategies, and to provide an update on current screening guidelines for individuals at average and high risk.
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Review
The Management of Women's Health Care by Internists With a Focus on the Utility of Ultrasound.
Adult women require routine care for the acute and chronic health problems found in both sexes, and they require specialized care for women's health problems, including disease prevention, disease screening, and disease management. Internists should direct primary care and participate in specialized care and to the extent possible follow guidelines published by various professional organizations. They should understand the use of ultrasound in breast cancer screening, the management of pregnancy, and other gynecologic problems, including vaginal bleeding, pelvic pain, and investigation for pelvic malignancy. Finally, all management decisions need discussions on the potential benefit or harm in each step of a woman's care with an emphasis on personal preferences.
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Women with acute myocardial infarction (AMI) have poorer clinical outcomes than men. Elderly women present high risk of developing frailty and frail women with AMI have a higher prevalence of functional impairments than men on presentation, including physical and cognitive impairment. ⋯ Cognitive and physical decline are very common in frail women, and their prevalence increases with age. On the basis of existing literature, we may speculate that frail women with AMI should be studied with 5-m gait speed test and Mini-Mental State Examination before hospital discharge, for a better evaluation of physical status and global cognitive function.
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Multicenter Study
Fracture Risk Assessment Tool May Not Indicate Bone Fragility in Women With Type 2 Diabetes.
Diabetes carries a known risk of bone fracture despite high bone mineral density (BMD). The fracture risk assessment tool (FRAX) predicts the 10-year major osteoporotic fracture risk and hip fracture risk. We investigated the effects of clinical parameters on the FRAX score and evaluated the validity of FRAX for evaluating current bone fragility in diabetes subjects. ⋯ The FRAX major osteoporotic fracture risk without BMD does not correctly indicate current bone fragility in Japanese middle-aged women with type 2 diabetes.
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The aim of this study was to compute the event rate of patients with breast cancer (BC) using Bayesian network (BN) structure. ⋯ The BN structure in which time was as a mediator of predictors-event relationship could be presented as the optimal tool to compute the event rate of BC. The findings could be used to identify the high risk patients and recommend for health policy making, prevention and planning for decrease the mortality in patients with BC.