By K. Killian. Oklahoma Baptist University. 2017.
There was a standard way to fill the test tubes cheap 20mg adalat mastercard, a standard way to spin them in the centrifuge cheap 30 mg adalat mastercard, and even a standard way to wash them up. W hen I finally published m y research, som e 900 hours of drudgery was sum m ed up in a single sentence: "Patients’ serum rhubarb levels were m easured according to the m ethod described by Bloggs and Bloggs [reference to Bloggs and Bloggs’ paper on how to m easure serum rhubarb]". I now spend quite a lot of m y tim e doing qualitative research and I can confirm that it’s infinitely m ore fun. I and m y research team spent an interesting few years devising a unique com bination of techniques to m easure the beliefs, hopes, fears, and attitudes of diabetic patients from a particular m inority ethnic group (British Sylhetis). W e had to develop, for exam ple, a valid way of sim ultaneously translating and transcribing interviews which were conducted in Sylheti, a com plex dialect of Bengali which has no written form. W e found that patients’ attitudes appear to be heavily influenced by the presence in the room of certain of their relatives, so we contrived to interview som e patients in both the presence and the absence of these key relatives. I could go on describing the m ethods we devised to address this particular research issue15 but I have probably m ade m y point: the m ethods section of a qualitative paper often cannot be written in 173 H OW TO READ A PAPER shorthand or dism issed by reference to som eone else’s research techniques. It m ay have to be lengthy and discursive since it is telling a unique story without which the results cannot be interpreted. As with the sam pling strategy, there are no hard and fast rules about exactly what details should be included in this section of the paper. You should sim ply ask "H ave I been given enough inform ation about the m ethods used? Question 6 What methods did the researcher use to analyse the data and what quality control measures were implemented? The data analysis section of a qualitative research paper is where sense can m ost readily be distinguished from nonsense. H aving am assed a thick pile of com pleted interview transcripts or field notes, the genuine qualitative researcher has hardly begun. It is sim ply not good enough to flick through the text looking for "interesting quotes" which support a particular theory.
The age-speciﬁc incidence of breast cancer rises until age 70 to 74 best adalat 30 mg, and then declines somewhat generic adalat 30mg overnight delivery, but not below the average risk of women aged 60 to 64 (72,73). Approximately 45% of new breast cancer cases and deaths occur in women aged 65 and older (1,46). Second, although tumor growth rate is slower (31), and breast cancers tend to be less aggressive in older women (31,74), it is important to emphasize that breast cancer is a potentially lethal disease at any age, and these tumor characteristics combined with declining breast density with age mean screening is somewhat less of a challenge in older women compared with younger women. Third, although only one RCT included women over age 69, observational studies have concluded that the effec- tiveness and performance of mammography in women over age 70 is equivalent to, if not better than, the screening of women under age 70 (75,76). Finally, although rates of signiﬁcant comorbidity increase with increasing age (77) and longevity declines, the average 70-year-old woman is in good health with an average life expectancy to age 85 (78). Thus, a sig- niﬁcant percentage of the population of women age 70 and older have the potential to still beneﬁt from early breast cancer detection. The American Cancer Society (ACS) recommends that chronological age alone should not be the reason for the cessation of regular screening, but rather screening decisions in older women should be individualized by considering the potential beneﬁts and risks of mammography in the context of current health status and estimated life expectancy (52). If a woman has severe functional limitations or comorbidities, with estimated life expectancy of less than 3 to 5 years, it may be appropriate to consider cessation of screening. However, if an older woman is in reasonably good health and would tolerate treatment, she should continue to be screened with mammography. Summary of Evidence: Current guidelines for breast cancer screening rec- ommend breast cancer screening intervals of either 1 year (52) or 1 to 2 years (39). Current evidence suggests that adherence to annual screening has greater importance in premenopausal women compared with post- menopausal women. Supporting Evidence: Current recommendations for the interval between screens are inﬂuenced by different approaches to evidence-based medicine. Other guideline groups have drawn inferential guidance from the RCTs, including the proportional inci- dence of interval cancers in the period after a normal screening, and esti- Chapter 3 Breast Imaging 37 mates of the duration of the detectable preclinical phase, or sojourn time, to deﬁne screening intervals. Tabar and colleagues (31) used data from the Swedish Two County study and estimated the mean sojourn time for women by age as follows: 40 to 49, 2. Since the average sojourn time properly should deﬁne the upper boundary of the screening interval, it becomes clear that annual screening is more important for younger women. Data from two trials (44,47) and inferential evidence used to estimate sojourn time (29,79) have provided persuasive evidence that younger women likely will beneﬁt more from annual screening compared with screening at 2-year intervals.