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Simulated results for screening strategies to prevent Colon Rectal Cancer (CRC)
Variable
Screening Strategy
No
Screening
DNA
(3yrs)
DNA
(5yrs)
DNA
(10yrs)
Occult
Blood
Flexible Sigmoid.
(5yrs)
Colonoscopy
(10 yrs)
2,917
2,435
2,654
2,710
2,129
2,253
1,780
b. CRC deaths, n
1,729
1,345
1,467
1,574
1,059
1,328
1,077
c. Perforation deaths, n
12
e. Reduction in CRC
incidence, %
17
27
23
39
22
15
39
23
39
15.7337
15.7476
15.7434
15.74
15.7584
15.7477
15.759
22,022
35,637
31,077
26,856
19,824
24,909
21,843
1,390
970
626
2,464
1,383
2,530
13,615
9,054
4,834
-2,198
2,887
-180
9,794
9,335
7,717
Dominant
2,087
Dominant
* Values obtain from a cohort of 100,000 persons 50 years of age who were followed for 25 years.
The other screening strategy is more effective and less costly than stool DNA testing strategy.
_____________
Reference:
Wu, Grace HM. Wang, Yi-Ming . Yen, Amy MF. Wong, Jau-Min Lai, Hsin-Chih Warwick, Jane and Chen,
Tony HH. (2006) Cost-effectiveness analysis of colorectal cancer screening with stool DNA testing in
intermediate-incidence countries. BMC Cancer 2006, 6:136 doi:10.1186/1471-2407-6-136
QUESTIONS: In your own words and
1) From the research results shown in the chart above, which type of screening had the highest and
which had the lowest reduction in colon-rectal cancer mortality?
2) How do you interpret the findings (Conclusion) in regard to the A-K results in regard to the
cost/effectives of doing DNA-testing at 3 years, 5 years, 10 years, or not doing DNA tests at all?
NOTE: Essay Question is in 2 parts. This is Part 1 to be completed and then go <next>, to Part 2 and
complete it.
Case #2 of 2: Cost/Benefit literature review for vaginal birth after cesarean (VBAC)
A client had a cesarean delivery in a hospital setting for breech presentation with her first pregnancy. She
is pregnant again and after exploring her delivery options, has decided she wants to attempt a vaginal
birth after cesarean (VBAC). She has had an uncomplicated pregnancy this time and the fetus is not
breech. The same OB-GYN will be assisting in her delivery. The OB-GYN performs a systematic review of
the literature to assess the benefits and harms of VBAC versus repeat cesarean delivery.
Part 1 of 2: Researching Empirical Evidence
1. What kinds and sources of data does the OB-GYN need to review in order to make a rational clinical
planning decision?
2. Which types of studies available on this topic would be the most useful in clinical decision making?
3. What types of studies would you want to exclude?
2. NOTE: This is Part 2 of the final essay question: The last essay question requires you to do a 2x2
table in addition to calculations. The tables may be done by copying the table from the question directly
into your answer and then filling the table out.
(Part 2 of 2): Construct the following for 1 and 2 and answer question 3
1. Construct a 2 x 2 table, calculate, and interpret the odds ratio of women who suffered a serious
adverse outcome from attempting a VBAC delivery in order to estimate the relative risk to a mother
delivering VBAC in midwifery based freestanding birthing centers. Cases are those with a serious
outcome, controls are those without. The exposure is treatment in a birthing center. The not exposed
group is treatment in a hospital.
Exposure
Cases
Controls
Birthing Center
Hospital
2. Construct a 2 x 2 table, calculate, and interpret the odds ratio of infants who suffered a serious adverse
outcome (including death) from attempting a VBAC delivery in order to estimate the relative risk to an
infant delivered VBAC in midwifery based freestanding
Controls
3. What does the midwife conclude regarding the safety to mother and baby by attempting a VBAC in
midwifery based birthing centers? What clinically is the best decision for this client and her unborn baby?