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The Primary Care RAP Hot Sheet: March 2017

Andrew Buelt, DO, Joe Weatherly, DO, and Heidi James, MD
00:00
05:36

No me gusta!

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This month, Andrew and Joe suffer from some entertaining loosening of associations as they connect obscure March holidays to recent studies on flexible sigmoidoscopy, lung cancer screening, and metformin in chronic kidney disease. (Spoiler: Awkward Moment Day is an actual thing.)

 

Holme, Øyvind, et al. "Effectiveness of flexible sigmoidoscopy screening in men and women and different age groups: pooled analysis of randomised trials." BMJ 356 (2017): i6673.

 

Yousaf-Khan, Uraujh, et al. "Final screening round of the NELSON lung cancer screening trial: the effect of a 2.5-year screening interval." Thorax72.1 (2017): 48-56.

 

Crowley, Matthew J., et al. "Clinical Outcomes of Metformin Use in Populations With Chronic Kidney Disease, Congestive Heart Failure, or Chronic Liver DiseaseA Systematic ReviewMetformin Use in Populations With CKD, CHF, or CLD." Annals of Internal Medicine (2016).

Ian L., Dr -

Itwould be worthwhile to add the FIT and Fecal DNA stool test to a Flexible Sigmoidoscpy Flexible Screening Sigmoidoscopy can be accurately performed by trained nurse endoscopists as shown in a trial in Gastroenterology 1999 Aug 117 (2) 312-318 by Schoenfeld et al : Accuracy of polyp detection by gastroenterologist and nurse endoscopists during flexible sigmoidoscopy .
So it is disappointing that more of these screenings are not performed with the Fecal FIT and DNA stool tests .
In High Risk it is worth starting screening at 35-40 .

Heidi J., MD -

Hi Ian - Thanks for your comment.

Andre w Buelt's response: "If you are already doing a FIT no need for the flex sig--- it will only increase your false positives and type 1 error for what is already known via the FIT/DNA."

Joe Weatherly's response: I would also add that if you are doing cologuard or the fecal DNA. There is absolutely no benefit from a screening flex sig as you are missing all right sided lesions and as we have discussed that is where the money is in a large cohort

My thoughts: FIT alone, or flex sig plus FIT, is undoubtedly far more cost efficient than C-scopes for all.

Ian L., Dr -

Flexible Sigmoidoscopy reveals earlier precancerous in the distal colon far better than the stool tests and it's use in patients who eat meat a lot drink Alchohol are overweight and smoke would yield a lot .
Unfortunately these high risk cohorts would avoid this test like the plague unless part of a massive trial in which they had large deductions from their health costs .
The other great advantage would be if you can prevent a low rectal carcinoma you would much less likely need a Colostomy Bag .

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The Primary Care RAP Hot Sheet: March 2017 Full episode audio for MD edition 5:37 min - 3 MB - M4A