10/20/2015. Teen to Elder Years. Cheryl Jackson DNP, FNP.

Transcription

1 Teen to Elder Years Cheryl Jackson DNP, FNP List current USPSTF recommendations for screening Examine changes in recommendations Identify components of a complete sexual history Low T claims and reality #1 : teens to age 45: unintentional injury #1: age 45 54, 65+: heart disease #1: age 55 64: cancer #2: teens: homicide or suicide #2: ages 45 and up heart disease or cancer 1

2 A: offer; high certainty substantial benefit B: offer; high certainty moderate benefit OR moderate certainty benefit is moderate to substantial C: offer depending on client selection; moderate certainty net benefit is small D: discourage; no net benefit OR R>B I: current evidence insufficient to assess R:B BMI age 18 BP: age 18 then q 2 years* Cholesterol: age 35 ( if risk factors) then q5 ASA: ages (B:R considered, family risks) Depression: teens and up* Diabetes: if BP > 135/80* Tobacco use: age 18 and up AAA:65 75 smoked 100 cigarettes or more HIV: one time (and prn if high risk) Hepatitis C: born time (& risk based) STI: assess risk summary/abdominal aorticaneurysm screening?ds=1&s=aaa%20screening 2

3 Colorectal: age (assess risk) (varies) Lung: asymptomatic w/30 pack year hx. and smokes OR quit in past 15 years (annual) low dose CT Skin cancer: years w/fair skin* *under update 2011 recommendation not to screen Evidence inadequate for TSE & provider exam Low incidence (1/263) high cure rate (73 99%) Potential harms: false positive rates high, anxiety, harm from procedures 3

4 2012 Do NOT use PSA for screening High false positive (80% with cut off 2.5 4υg/L) Negative psychologic effects Unnecessary testing & complications Screening: Die of prostate cancer w/o screening 5/1000 Will die with screening 405/1000 Do not die because of screening 0 1/1000 PSA testing is individualized Low PSA no cancer High PSA cancer (10 or more is of concern) African Americans: higher incidence of prostate cancer also have higher PSA Biopsy is not risk free Age of patient and health status The only reason not to do a digital rectal examination is if the patient is without a rectum or the clinician is without a finger Unfortunately, the finger is not a sensitive instrument 4

5 Age 50 56: PSA below median PSA[1.1 ng/ml] < 1% risk (Vickers AJ, Ulmert D, Sjoberg DD, et al.,2010) Age 60: PSA <2 ng/ml still have risk; >2ng/mL PPV for screening high [NNT=23] (Vickers A, Cronin A, Bjork T, et al., 2010) If consistent PSA >1ng.mL but <2ng/mL consider DC screening Prostate Cancer Research International Active Surveillance (PRIAS) protocol Goals: monitor disease to delay or avoid invasive treatment Methods: PSA and biopsy Candidates: life expectancy, PSA <10, volume<20ml, Gleason 3+3, normal DRE Watchful waiting symptomatic treatment Teens part of broader risk assessment Home School Drug use Smoking Developmentally appropriate Alone, confidentially Adults context of overall health 5

6 Patient centered care Improve patient provider relationship Opportunity for education Allow for appropriate referrals Prevent complications & disease spread Behaviors can change Be aware of your sexual identity and assumptions towards sexual expression Avoid assumptions about the patient s sexual orientation, behaviors, number of partners Straightforward but sensitive, nonjudgmental Interview provider or other team member Paper or electronic consider privacy, literacy level Have you been sexually active in the last year? Do you have sex with men only, women only, or both? (If both, ask the next question twice once for male partners, and once for female partners.) How many people have you had sex with in the past six months? 6

7 Partners number, gender Practices type of activity, condom use Past infections GC, chlamydia, herpes, warts Pregnancy history & plans desired Protection from STDs What do you do to protect yourself from sexually transmitted diseases and HIV? %20Health%20Toolkit%20FINAL%20May% pdf It is the cause of: Fatigue, loss of energy Weight gain, decreased muscle mass Decreased sexual performance Depression Decreased physical performance All that is wrong in the world! Testosterone is the fountain of youth! Testosterone normally decreases throughout life beginning around age 30 Levels are highest in AM Hypogonadism is: T testosterone < 300 ng/dl 39% of men have hypogonadism prevalence 7

8 Decrease spontaneous erections Breast discomfort Loss of body hair Small/shrinking testes Hot flashes/sweats Inability to father children Loss height, low bone mineral density Fenugreek Tribulus terrestis Longjack Foreskolin Vitamin D Zinc DHEA increase free testosterone Increase pituitary production of LH to signal testosterone production in testes deficiency can contribute to low testosterone synthesized from cholesterol, testosterone precursor Pregnenolone synthesized from cholesterol, converts to DHEA 8

9 support male vitality support male reproductive function and healthy testosterone levels psychological benefits comparable to fully hormonal products without potential side effects High T increase vitality, stamina PrimalJax TribululusTerrestris Mucana Pruriens Maca LJ100 Tongkat Ali King Oyster TestoJack 100 (Testo FactorX) Teston 6 Interactions with medications Not FDA controlled inconsistent quantities, purity Often found to include banned substancessynthetic steroids [Androstenedione], ephedra, clenbuterol, gr0wth factors Questionable effectiveness poor or no studies, anecdotal information Increased growth of aggressive prostate cancer (Teston ) Liver damage Lost $$$$ 9