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The 15 percent to 20 percent lower lung cancer death rate is equivalent to approximately three fewer deaths per 1, people screened in the CT group compared to the chest X-ray group over an average of 6. Were there any other important findings from...
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On average, over all three screening rounds, Among people who had multiple annual screens up to three screens Diagnostic evaluation most frequently consisted of further imaging, and invasive procedures were rare. Across the three rounds, when a...
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CT screening decreases your risk of dying only for lung cancer, not other conditions. While it is never too late to quit smoking, the sooner a person quits the better. Finally, many participants in the trial died of lung cancer despite receiving CT screening. In fact: Cigarette, cigar, and pipe smoking all increase the risk of lung cancer. Tobacco smoking causes about 9 out of 10 cases of lung cancer in men and about 8 out of 10 cases of lung cancer in women. Studies have shown that smoking low tar or low nicotine cigarettes does not lower the risk of lung cancer. Studies also show that the risk of lung cancer from smoking cigarettes increases with the number of cigarettes smoked per day and the number of years smoked.
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People who smoke have about 20 times the risk of lung cancer compared to those who do not smoke. Quitting smoking is hard, but there are many proven treatments that can help. At that phone number, NCI smoking cessation counselors can give help quitting smoking and provide answers to smoking-related questions in English or Spanish, Monday through Friday, from a.
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Not necessarily. The NLST participants were a very specific population of men and women ages 55 to 74 who were heavy smokers. They had a smoking history of at least 30 pack-years but no signs or symptoms of lung cancer at the beginning of the trial. Pack-years are calculated by multiplying the average number of packs of cigarettes smoked per day by the number of years a person has smoked. It should also be noted that the population enrolled in this study, while ethnically representative of the high-risk U. Men and women in a similar age group and with a similar smoking history should be aware that not all lung cancers found with screening will be early stage.
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A screening CT looks for initial signs of disease in healthy people while a diagnostic CT is done after a person has a sign or symptom of disease. What resources are available to physicians who evaluate lung nodules found via a CT scan? Other professional organizations have developed guidelines for evaluating many other types of lung nodules. The vast amount of data generated by NLST, some of which is still being studied, will greatly inform the development of clinical guidelines and policy recommendations.
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Those recommendations, however, are decisions that are being made by other organizations such as the U. The USPSTF now recommends annual screening for lung cancer with low-dose CT in people 55 through 80 years old with a 30 or more pack year history of smoking who are currently smoking or have quit within the past 15 years. They advise that screening should be discontinued once the individual has not smoked for 15 years or develops a health problem significantly limiting either life expectancy or ability or willingness to undergo curative lung surgery. They give lung cancer screening with low-dose CT a grade B recommendation.
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The grade of B denotes that the USPSTF has high certainty that the net benefit is moderate; or has moderate certainty that the net benefit is moderate to substantial. This contrasts with the NLST screening trial, which for reasons of cost and efficiency, included heavy smokers age at study entry who had three annual lung cancer screening exams.
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The five models were calibrated to the NLST results and predicted lung cancer outcomes consistent with the trial observations. The researchers evaluated over scenarios of annual or less frequent screening; for ages to start screening between 45 and 60 as well as ages to stop screening between 75 and 85; for a range of minimum smoking exposure measured in pack-years ; and the maximum time since quitting. CISNET models identified consensus strategies that were efficient, preventing the greatest number of lung cancer deaths for the screening exams required.
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Specifically, the investigators focused on 26 screening scenarios that started screening at age 50, 55 or 60 and stopped screening at age 80 or Among these 26 programs, screening every three years reduced lung cancer mortality by 5 percent to 6 percent, compared to screening every two years that reduced mortality by seven percent to 10 percent, and annual screening that offered reductions between 11 percent and 21 percent. For example, annual lung cancer screening of people with at least 30 pack-years of smoking and a maximum of 15 years since quitting who were between the ages of 55 and 80 offers one reasonable tradeoff between benefits and harms.
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Compar-able scenarios with a later starting age of 60 but increasing the maximum years since quitting to 25 years offer an alternative with a comparable tradeoff of benefits and harms. Extending eligibility to individuals with fewer pack-years, although still efficient among some of the scenarios considered, led to additional benefits but more corresponding harms. The primary difference between the modeling findings and the initial NLST study findings is that, instead of the age group of that was eligible for the trial deriving greatest benefit, the CISNET modeling shows that an age group of 55 to 80 of heavy smokers would benefit most from annual lung screening.
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However, the benefits of screening individuals at older ages is dependent on their underlying health status and the presence of illnesses that could increase the complication rates of a diagnostic evaluation and management of abnormalities identified by screening such as heart disease, etc. They can, however, provide valuable tools to project the results of the trial to different scenarios over the course of a lifetime, and given calculations of harms and benefits, show which ones provide the greatest benefits for a specified level of harm. Are there radiation exposure risks associated with repeat CT scans? The radiation exposures from the screening done in the NLST will be modeled to see how low-dose CT scans change a person's risk for cancer over the remainder of his or her life, but these analyses are complex, require a number of assumptions, and will take a while to conduct.
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Previous studies show that there can be an increased lifetime risk of cancer due to ionizing radiation exposure. It is important to recognize that the benefit of potentially finding a treatable cancer in current or former heavy smokers, ages 55 to 74, using helical CT appear to outweigh the radiation exposure risks of the procedure. For comparison purposes, a standard low-dose helical CT scan as used in the NLST delivers a small amount of radiation to several organs in the body, primarily the lung 4 mGy, or milligrays, which is a measure of absorbed radiation dose and the breast 4 mGy but also the red bone marrow, stomach, liver and pancreas each about 1 mGy. By comparison, a standard screening mammogram results in a similar radiation exposure to both breasts about 4 mGy but the doses to all other organs are negligible less than 0. The total whole body effective dose that is ultimately delivered via a CT scan is calculated as a weighted average of the dose to each organ and is therefore higher for a lung CT scan, about 1.
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As a final comparison, a chest X-ray delivers only about 0. Does screening with chest X-rays reduce lung cancer mortality? The PLCO, started in , looked at chest X-rays for lung cancer screening in half of its , participants. The other half received usual care from their health care providers and served as the control group. A special analysis of about 30, PLCO participants, who were similar in age and smoking history to the population of NLST participants, showed no lung cancer mortality benefit for those who got chest X-rays. A full analysis of the PLCO trial was published in ; it also showed no lung cancer mortality benefit for participants in the chest X-ray part of the trial. What additional questions will be answered as a result of the NLST? Some important questions that are currently being addressed, or will be addressed in the future using NLST data, are as follows: What medical resources are utilized when CT screening tests or chest X-ray tests are positive in individuals at high risk of lung cancer?
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What is the overall cost-effectiveness of CT screening in the most commonly accepted health services research metric: dollars per quality-adjusted life year? How does lung cancer screening affect an individual's quality of life overall, when the screening test is positive, and when the test determines that there is a lung cancer? How does lung cancer screening influence smoking behaviors and beliefs, both short-term and long-term? What early biomarkers for lung cancer in a group at high risk for lung cancer can be validated in the associated biospecimen archive blood, sputum, urine? Other information, such as germline inherited mutations that might predict increased risk of lung cancer, or somatic non-heritable mutations in the archived lung cancer specimens associated with outcomes from the cancer, may also be obtained. Background about the Trial Why was this study needed? Lung cancers, the vast majority of which are caused by cigarette smoking, are the leading cause of cancer-related deaths in the United States.
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This disease is expected to claim , lives in Lung cancer kills more people than cancers of the breast, prostate, and colon combined. There are more than 94 million current and former smokers in the United States, many of whom are at high risk of lung cancer. Most lung cancers are detected when they cause symptoms. By the time lung cancer is diagnosed, the disease has often already spread outside the lung. Therefore, researchers have sought to develop methods to screen for lung cancer before symptoms become evident. Helical CT, a technology introduced in the s, can detect tumors well under 1 centimeter cm , or 0. It is sometimes hypothesized that the smaller the tumor, the higher the chance of long-term survival. However, in other randomized trials, chest X-ray screening has not been found to reduce deaths from lung cancer, even though it does increase the detection of small tumors.
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The NLST, with a large number of participants in a randomized trial, was able to provide the evidence needed to determine whether low-dose helical CT scans are better than chest X-rays in helping to reduce a person's chances of dying from lung cancer. How do lung screening tests work? A chest X-ray produces a picture of the organs within a person's chest. Throughout the procedure, the person stands with the chest pressed to a photographic plate, hands on hips and elbows pushed forward. During a single, sub-second breath-hold, a beam of X-rays passes through the person's chest to the photographic plate, which creates an image.
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Research Methods- Qualitative vs. To decide which method is the best for your paper, you have to know the difference between the qualitative method and quantitative method. Qualitative method: This method is used when the deeper meaning of something needs to be found. It explores attitudes, behavior and experiences of people. The purpose of this method is to find the meaning of something, describe it and relate it to a certain cause. The main methods of qualitative research are: focus groups, observations, case studies etc. These are primary resources in which you get the necessary information first-hand. Qualitative research does not have some kind of measurements or statistics but instead it uses words, quotes and descriptions to make a point.
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Qualitative research is inductive which means that it moves from specific observations to broader generalizations and theories. Quantitative method: Quantitative research uses numbers, proportions and statistics which are generated from surveys or constructed interviews. Quantitative research uses the deductive approach which means that it goes from the more general to the more specific, from a theory to a specific conformation that needs to be proven. The researcher is ideally an objective observer that neither participates in nor influences what is being studied. Quantitative research is not best used when it comes to human attitudes, behaviors or beliefs. But even though the data is numerical, the results need to have a description and a relation to a cause. Neither of the methods is better than the other and both methods can used together to write a well-established research paper.
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Ethnography: the study of cultures through close observation, reading, and interpretation. The researcher that decides to do an ethnographic study needs to do a fieldwork which means to participate in the culture which they are studying. Ethnographic researches recognize culture traits. This method is used sociology, anthropology, education etc. All cultures distinguish themselves by patterns that are repeated. The ethnographer finds, records and interprets these patterns. Elements of culture are habits, customs, traditions, histories, and geographies—everything that connect the members of the culture together and defines them. Ethnographic research is qualitative.
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The researcher is concerned with analyzing and interpreting specific patterns or traits of a culture and not with statistics or comparisons between different cultures in terms of numbers. Because researches are involved in the cultures they are studying, ethnographic research is subjective. The main purpose of ethnographic study is to find and explain hidden traits and meaning that are not visible to others. Ethnographic research is a rhetoric act, because it is used to persuade others using their study and experience with a particular culture. An ethnographer is interested not only in the facts but also in what those facts mean and how they might explain that specific culture. The main methods of ethnographic research are: observations, interviewing, collecting cultural artifacts, secondary sources like articles etc. Ethics in research One of the main concerns when it comes to ethics in research is plagiarism. Citing sources not only avoids plagiarism but it also enhances your credibility as a writer and demonstrates that you have studied the subject in depth, using credible sources.
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All the sources: interviews, surveys, focus groups, printed articles, internet articles need to be cited in a proper way. There are other concerns regarding ethics in research. One of them is The principle of voluntary participation which requires that people are not forced to participate in a particular study. The requirement of informed consent is basically letting the participants know about the procedures and risks of research and they have to give the consent of participating. Confidentiality - identifying information will not be made available to anyone who is not directly involved in the study.
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Anonymity means that the participant will remain anonymous throughout the study. Reading texts and discerning the arguments Rhetoric is the art of persuasion. The researchers and writers are engaged in arguments that they used to persuade the readers. Writing can be classified in two categories: argumentative and non-argumentative. Argumentative writing has to defend a position in a debate ; it must be on a controversial topic; and the goal of such writing must be to prove the correctness of one point of view over another. On the other hand, non-argumentative texts include narratives, descriptions, technical reports, news stories, and so on. Research writing is known to be non-argumentative because researchers tend to be more concerned with collecting information and data and not engaging to explain and relate those data to arguments. We should think of "argument" as an opportunity for conversation and for sharing with others our point of view on something. Arguments then, can be explicit and implicit.
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Explicit arguments contain noticeable and definable thesis statements and lots of specific proofs. Implicit arguments, work by weaving together facts and narratives, logic and emotion, personal experiences and statistics. Developing research questions. A research question is a formal statement of the goal of a study. The research question states clearly what the study will investigate or attempt to prove. The question has to be neither too broad nor too specific. If it is too broad there is a lot of information and data that can be relevant and the paper will end up being too confusing. If the question is too specific there may not be enough data to answer that question in a proper argumentative form.
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Exams Questions And Answers On Research Methods
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