Preventive care guidelines: 1991
Article Abstract:
Preventive care includes those strategies most likely to provide useful information on the state of a person's health, such as certain aspects of a physical examination, specific laboratory studies, and counselling about habits, all with the goal of identifying illness or the potential for illness at a stage early enough for prevention of serious health problems. A number of medical authorities and organizations have published preventive care recommendations, some with extensive background information justifying their recommendations and others with little in the way of strong statistical support. For example, the annual physical examination has never been shown to detect enough occult (masked) or potential illness to justify its costs. Some interventions that have proven useful over the years and which are generally recommended by various authorities include blood pressure measurement, at least every other year in normal people (all interventions should be performed at more frequent intervals for those patients with specific health problems or risks). Routine urine analyses, performed by many physicians at the time of physical examinations, are considered unnecessary by many authorities. A resting electrocardiogram is felt to be of little value in a healthy person without risk factors for cardiac disease. Most authorities agree on the value of counselling patients about good health habits, such as not smoking, moderating the intake of alcohol, eating a low-fat, low-cholesterol, high-fiber diet, and the use of seat belts. A number of obstacles exist to including preventive strategies in general medical practice, such as a lack of time for such counselling, a lack of reimbursement for such services, and some skepticism on the part of physicians that such interventions are of value. However, the decrease in the incidence of cardiovascular disease demonstrates that preventive interventions, such as smoking cessation, blood pressure monitoring, and dietary counselling, can be of benefit. An extensive table of specific recommendations for obtaining and evaluating a medical history and physical examination is presented. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Annals of Internal Medicine
Subject: Health
ISSN: 0003-4819
Year: 1991
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Echocardiographic identification of cardiovascular sources of emboli to guide clinical management of stroke: a cost-effectiveness analysis
Article Abstract:
In patients with new-onset stroke, using a specific imaging method called transesophageal echocardiography to look for the formation of blood clots in the heart may be a cost effective method of reducing the chance of further strokes. Projected risks, costs, and benefits of nine methods to diagnosis and treat the presence of blood clots in the heart were evaluated for hypothetical 65-year-old patients with new-onset stroke and normal heart function. Transesophageal, as opposed to transthoracic, echocardiography appeared to be cost effective when used to detect blood clots and initiate anticoagulation therapy.
Publication Name: Annals of Internal Medicine
Subject: Health
ISSN: 0003-4819
Year: 1997
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