Women's Health, Aging and Evidence-based care

1. COORDINATING CARE OF
CHRONICALLY ILL WOMEN (≥ 45
YEARS) WITH MULTIPLE CO-
MORBIDITIES
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2. ROADMAP
 Menopause
 Alternative medicine
 HRT
 Weight Management
 Cardiovascular health
 Diabetes
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3. SOURCE OF EVIDENCE
 Critical Appraisal Topics (CATS)
 Attract
 Systematic Reviews
 Bandolier
 Cochrane Library
 Clinical Practice Guidelines
 National Guidelines Clearinghouse
 Trip-database
 Centre For Reviews and Dissemination
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4. CRITICAL APPRAISAL TOPICS (CATS)
ATTRACT
 HRT – [search-strong; appraisal-weak; confidence-
mod] http://bit.ly/vt19kD
 Is there any evidence that hypertension combined with
HRT gives increased risk of cardiovascular
complications? [search-mod; appraisal-mod; confidence-
weak] (http://bit.ly/tvVe71)
 In a woman with previous hysterectomy and history of
stroke (16 years ago) is HRT absolutely contraindicated.
[search-mod; appraisal-mod; confidence-weak]
 Does menopause have any effect on glycaemic
control[search-strong; appraisal-weak; confidence-mod]
http://bit.ly/vj9I98)
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5. SYSTEMIC REVIEWS (BANDOLIER & SIGN)
 Menopause and Alternative Medicine
 http://bit.ly/uGqEkE
 HRT and fracture risk
 http://bit.ly/v4ET55
 Weight Management (Exercise and bone
density)
 http://bit.ly/sEkBwb
 Cardiovascular Health (walking briskly for 3
hours)
 http://bit.ly/v3t9fb
 Management of diabetes
 http://www.sign.ac.uk/pdf/qrg116.pdf 5

6. CLINICAL PRACTICE GUIDELINES – NGC
Menopause
 Estrogen and progestogen use in postmenopausal
women (http://1.usa.gov/vNtOXL)
Cardiovascular Health
 Cardiovascular disease in Menopause
(http://1.usa.gov/vjPDAU)
 AAC Endocrinologists medical guidelines for clinical
practice for the diagnosis and treatment of
menopause (http://1.usa.gov/sXI0GS)
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7. CLINICAL PRACTICE GUIDELINES – TRIP-
DATABASE
Menopause
 13,976 all evidence
 268 evidence synopsis
 618 systematic reviews
 HRT
 2,724 all evidence
 69 evidence Synopsis
 140 systematic reviews
 Diabetes
 1,727 all evidence
 30 evidence Synopsis
 41 systematic reviews
 Cardiovascular Health
 823 all evidence
 61 evidence Synopsis
 78 systematic reviews 7

8. CENTER FOR REVIEW & DISSEMINATION –
CARE COORDINATION
Aim
 Development of a deep approach to the coordination between
Primary and Specialized Healthcare
 Help improve the coordination among the different stages,
identifying some improvement areas and finally, we should set
some priorities in the detected lines of work.
 Results suggest:
 Relevant improvement areas in the field of communication
 The professionals helps shared medical history an important
improvement in the field of coordination
 The human factor is fundamental in the coordination.
 Promote mutual understanding among the professionals
 They were not been able to go as much into the values and
attitudes in depth as we had expected
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 http://bit.ly/stAhJj

9. Empowering women to live healthier lives!
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