The Guide to Clinical Preventive Services includes U.S. Preventive Services Task Force (USPSTF) recommendations on screening, counseling, and preventive medication topics and includes clinical recommendations for each topic. This new pocket guide provides family physicians, internists, pediatricians, nurses, nurse practitioners, physician assistants, and other clinicians with an authoritative source for making decisions about preventive services. The clinical summaries in this Guide are abridged versions of recommendations from the U.S. Preventive Services Task Force (USPSTF). To view the full recommendation statements, supporting evidence, or recommendations published after March 2014, go to http://www.USPreventiveServicesTaskForce.org Each of the abridged clinical summaries include the following criteria: · Title · Population · Recommendation · Risk Assessment · Screening Tests · Interventions · Balance of Benefits and Harms · Other Relevant USPSTF Recommendations
The Guide to Clinical Preventive Services includes U.S. Preventive Services Task Force (USPSTF) recommendations on screening, counseling, and preventive medication topics and includes clinical recommendations for each topic. This new pocket guide provides family physicians, internists, pediatricians, nurses, nurse practitioners, physician assistants, and other clinicians with an authoritative source for making decisions about preventive services.
This report updates an evidence synthesis commissioned by the U.S. Preventive Services Task Force (USPSTF) and completed in March 2005, on screening for unsuspected human immunodeficiency virus (HIV) using HIV antibody (Ab) tests in non-pregnant adolescents (aged 13 to 18 years old) and adults. This brief update was requested by the USPSTF to determine whether there is sufficient new evidence to justify revision of recommendations based on the 2005 evidence synthesis. A key reason for this update is the release in September 2006 of revised Centers for Disease Control and Prevention (CDC) recommendations advising routine voluntary HIV screening of most U.S. adolescents and adults. The 2005 USPSTF recommendations differ from the revised CDC recommendations in that they do not recommend for or against routine screening non-pregnant adults and adolescents who do not report risk factors and are not in high-prevalence (greater than 1%) or other high-risk settings. Staff at the CDC have indicated that the agency's expanded screening recommendations are based primarily on new evidence as to the effects of HIV screening on transmission risk. This report focuses on new or “breakthrough” evidence that could affect the 2005 USPSTF recommendations regarding routine screening of low- or average-risk adults and adolescents. This update reviews new evidence on HIV screening not included in the 2005 evidence synthesis. It focuses on evidence in non-pregnant, adults and adolescents who do not report risk factors and are evaluated in lower-prevalence (less than 1%), low-risk clinical settings (referred to in this report as 'low-risk' persons), because this is the population for which the USPSTF and the 2006 CDC recommendations are discordant. In the 2005 evidence review, we identified several key areas where additional evidence could strengthen the case for screening in low-risk populations. These include gaps in the research regarding uncertainties about the acceptability of routine voluntary screening in low-risk persons; the yield of targeted versus universal screening and optimal methods of risk assessment in low-risk settings; the impact on test uptake and follow-up of abbreviated or streamlined counseling methods and newer testing or sampling methods; and the effects of screening on HIV transmission rates. We therefore focused on studies that could help fill in these gaps. We also evaluated new evidence on the cost-effectiveness of routine HIV screening and studies on the frequency of testing.
This systematic review is an update for the U.S. Preventive Services Task Force (USPSTF) that addresses the effectiveness and adverse effects of behavioral interventions and counseling to prevent child abuse and neglect for children at potentially increased risk. This review focuses on children without obvious signs or symptoms of abuse or neglect who are seen in health care settings. A separate review examines screening women for intimate partner violence and screening for elder abuse. In 2004, based on results of a previous review of screening for abuse and neglect, the USPSTF found insufficient evidence to recommend for or against routine screening of parents or guardians for the physical abuse or neglect of children (I statement). The USPSTF could not determine the balance between the benefits and harms of screening because of the lack of critical evidence. Limitations included the following: Interventions were predominantly home visitation programs that utilized varied and often inadequately described components during the prenatal, postpartum, and early childhood periods. It is unknown whether these models would work in other populations or with older children; There were no studies of screening for child abuse and neglect in health care settings that reported health outcomes, including premature death and disability; There were no studies of the adverse effects of screening and interventions; There was no demonstration of a gold standard screening instrument. Instruments designed to screen for child abuse and neglect had fairly high sensitivity in the few studies evaluating test performance, but they had low specificity. Instruments were primarily directed at pregnant women and lacked testing in other populations, particularly older children in the context of usual health care; Studies were conducted in high-risk populations; There were no studies of the feasibility of screening procedures and interventions in the primary care setting, including identification of barriers to screening. The purpose of this publication is to review new evidence on the benefits and harms of behavioral interventions and counseling in health care settings to reduce child abuse and neglect and related health outcomes for the U.S. Preventive Services Task Force.
Lung cancer is the second leading cause of cancer in the United States and the leading cause of cancer-related death among men and women. Worldwide, lung cancer and lung cancer related deaths have been increasing in epidemic proportions, largely reflecting increased rates of smoking. In the year 2003, the American Cancer Society predicted that there would be approximately 171,900 new cases of lung cancer diagnosed and approximately 157,200 lung cancer-associated deaths in the United States. Worldwide, it is estimated that there were 1 million deaths in the year 2000. Cigarette smoking is the major risk factor for lung cancer, causing approximately 87% of lung, bronchial, and tracheal cancers. Other risk factors include family history, chronic obstructive pulmonary disease, idiopathic pulmonary fibrosis, environmental radon exposure, passive smoking, asbestos exposure, and certain occupational exposures., In addition, for a given amount of tobacco exposure, some studies suggest that women are at higher risk than men. By far the most important public health intervention that could reduce lung cancer incidence and deaths is changing smoking habits. For many of these reasons, screening for and treating early lung cancer is intellectually appealing. However, there are several important methodological issues that must be critically analyzed before considering widespread screening. Screening for lung cancer is not currently recommended by any major medical professional organization. The United States Preventive Services Task Force (USPSTF) gave lung cancer screening a D. recommendation in both 1985 and 1996, meaning that there is fair quality data to recommend against screening for lung cancer. This recommendation was largely based on three negative United States trials conducted in the 1970s, 1 evaluating chest x-ray and 2 evaluating sputum cytologic screening. However, since the last Task Force review, several new studies of lung cancer screening have been reported, and greater attention has been directed toward the limitations of existing literature. This review examines studies of lung cancer screening to aid the current US Preventive Services Task Force in updating their recommendation.
The purpose of this report is to update a previous systematic review commissioned by the U.S. Preventive Services Task Force (USPSTF) on screening for asymptomatic HIV infection in nonpregnant adults and adolescents. In 2005, based on the earlier evidence review, the USPSTF recommended screening all adolescents and adults at increased risk for HIV infection (grade A recommendation). The USPSTF based its recommendation on the high yield of screening in these patients, good evidence that standard and rapid HIV screening tests accurately detect HIV infection, and good evidence that identification and treatment of unsuspected HIV infection at immunologically advanced stages of disease with antiretroviral therapy (ART) and other interventions results in marked reduction in risk of progression to acquired immunodeficiency syndrome (AIDS) and AIDS-related clinical events and mortality. Although the USPSTF found ART associated with short-term adverse events and increased risk of long-term cardiovascular events, it determined that estimated benefits greatly outweighed harms. The USPSTF made no recommendation for or against routinely screening for HIV in adolescents and adults not at increased risk for HIV infection (grade C recommendation). Because of the lower prevalence of HIV infection in persons not at increased risk, the USPSTF determined that benefits from screening would be smaller than screening in higher-risk populations, resulting in a close balance between potential benefits and harms, including false-positive results, labeling, anxiety, and adverse events associated with ART and other interventions. Importantly, the USPSTF found insufficient evidence to estimate benefits from screening in persons at less immunologically advanced stages of disease or effects of screening and subsequent interventions on risk of HIV transmission. In 2006, the Centers for Disease Control and Prevention (CDC) issued its revised guideline recommending routine voluntary HIV screening of all persons ages 13 to 64 years, unless the prevalence of undiagnosed HIV infection has been documented to be less than 0.1 percent. The CDC also recommended that testing be performed on an opt-out basis without a requirement for pretest prevention counseling, in order to reduce barriers to screening. A key reason for the differences between the CDC and USPSTF recommendations is evidence showing that 20 to 26 percent of patients with HIV infection report no risk factors, suggesting that any screening strategy based on risk factor identification will miss an important proportion of infected persons. Other reasons for the differences between the CDC and USPSTF recommendations include greater weight placed by the CDC on studies showing reductions in self-reported risky behaviors following diagnosis of HIV infection, acceptance of modeling studies to estimate effects of HIV diagnosis and reductions in risky behaviors on transmission risk, and greater weight placed on studies showing acceptable incremental cost-effectiveness ratios for screening versus no screening in very low-prevalence populations. The USPSTF subsequently commissioned a focused update of its 2005 report with the studies included in the CDC guideline, but found insufficient evidence to change its C recommendation on screening in persons not at higher risk. The USPSTF found methodological shortcomings in the studies showing reduced risky behaviors following HIV diagnosis, which made estimations of reductions in transmission risk unreliable. This report updates the prior USPSTF review on the benefits and harms of HIV screening in nonpregnant adolescents and adults, focusing on key research gaps identified in the earlier review. This report also addresses areas not addressed in the prior USPSTF review, including effects of different screening methods on uptake, CD4 count at diagnosis, linkage to followup care, and harms, in order to help inform optimal screening strategies.
This report is a staged systematic review to update the 1996 U.S. Preventive Services Task Force (USPSTF) recommendation on screening for drug misuse. The USPSTF previously concluded there was insufficient evidence to recommend for or against routine screening for drug misuse in primary care. This report examines whether the evidence for the critical key questions is now sufficient for the USPSTF to make a recommendation on this topic. This report also includes “Screening in Primary Care Settings for Illicit Drug Use - Part 2 'Assessment of Screening Instruments — A Supplemental Evidence Update for the U.S. Preventive Services Task Force.'” Illicit drug use and abuse are serious problems among adolescents, adults, and pregnant women in the United States. To update this topic, we utilized an analytic framework with eight Key Questions: KQ 1. Is there direct evidence that screening for drug misuse reduces morbidity and/or mortality? KQ 2. Do screening tests accurately detect drug misuse? KQ 3. Does screening for drug misuse result in adverse effects? KQ 4. Does treatment for drug misuse among individuals identified through screening improve morbidity and/or mortality? KQ 5. Does treatment for drug misuse among individuals identified through screening result in decreased drug misuse? KQ 5a. Does treatment for drug misuse reduce risk behaviors or improve social and legal outcomes? KQ 6. Does treatment for drug misuse result in adverse effects? KQ 7. Is decreased use or abstinence following drug misuse reliably associated with reduced morbidity and mortality? Part 2 'Assessment of Screening Instruments — A Supplemental Evidence Update for the U.S. Preventive Services Task Force' - Two approaches have been proposed for identifying illicit drug use and drug abuse among patients seen in routine clinical encounters: toxicologic tests of blood or urine, and standardized screening questionnaires. This report focuses only on the second approach. While toxicologic testing can provide objective evidence of drug use, false-positive results due to cross-reactions, contamination, or mislabeled specimens are always possible. More importantly, these tests do not distinguish between occasional users and individuals who are dependent on or otherwise impaired by drug use. At the time the USPSTF last examined the use of standardized screening questionnaires for detecting potential drug problems among patients, few screening instruments had been developed specifically for that purpose, and none had been validated in prospective studies. Most of these are modifications of validated alcohol screening instruments. Some were developed for self-administration by patients; others are screening tools for clinicians or clinical practice staff to administer and score; still others are simply a list of questions intended to guide clinician interviews. The instruments vary significantly in length and in the amount of time required to complete them. To be of benefit in primary care settings, a standardized screening instrument must not only be accurate and reliable in detecting patients with a potential problem: it must also be short and easy to administer so that an undue burden is not placed on the patient or practice staff when it is applied in the busy practice setting. The goals of this review were (1) to identify standardized instruments described in the medical literature that have been designed for detecting use/abuse of illicit drugs; (2) to select those instruments reasonably short enough to have the potential for routine use in a busy primary care practice setting; (3) to determine the extent of published evidence about the accuracy (sensitivity and specificity) and the reliability of potentially useful instruments, and rate the quality of that evidence; and (4) to determine the extent to which validated instruments have been assessed for feasibility and utility when applied in primary care practice settings and among various patient populations.
We undertook this systematic review to assist the U.S. Preventive Services Task Force (USPSTF) in updating its 2003 recommendation on cervical cancer screening. During the planning phase of this evidence review on cervical cancer screening, the Agency for Healthcare Research and Quality decided to fund a separate modeling study to be conducted simultaneously. The USPSTF determined that the scope for both the systematic review and the modeling study would focus on important clinical questions that could inform effective use of screening in practice. This systematic review focuses on when to begin screening and on updating test accuracy and harms data on liquid-based cytology (LBC) and human papillomavirus (HPV) testing, either alone or in combination with cytology. The modeling study focuses on the effectiveness of strategies that use different ages at which to begin screening and different screening intervals. These two reports are intended to provide the USPSTF with complementary information to update its recommendation on cervical cancer screening. Using the USPSTF's methods we developed an analytic framework and five key questions (KQs) to guide our literature search. These KQs include: KQ1: When should cervical cancer screening begin, and does this vary by screening technology or by age, sexual history, or other patient characteristics? KQ2: To what extent does liquid-based cytology improve sensitivity, specificity, and diagnostic yield and reduce indeterminate results and inadequate samples compared to conventional cervical cytology? KQ3: What are the benefits of using HPV testing as a screening test, either alone or in combination with cytology, compared with not testing for HPV? KQ4: What are the harms of liquid-based cytology? KQ5: What are the harms of using HPV testing as a screening test, either alone or in combination with cytology?This report's scope differs from the 2002 USPSTF evidence report in several ways. KQ1, which was not included in the 2002 evidence report, addresses when cervical cancer screening should begin. Both LBC and automated screening technologies were evaluated in the prior review, and the evidence was determined to be insufficient to recommend for or against the use of these technologies in cervical cancer screening programs. For this review, we updated the evidence regarding LBC (KQ2) and focused on studies that evaluated either ThinPrep or SurePath, which are both FDA approved. The previous review evaluated the sensitivity and specificity of the HPV test for detection of histologically proven HSIL and LSIL. The authors also evaluated the use of the HPV test as a tool to facilitate triage of women with abnormal cytology. The current review expanded the scope of KQ3 to evaluate the evidence regarding the use of HPV testing in the following scenarios: 1. Primary screening with HPV test alone. 2. HPV testing with cytology triage of positive HPV (reflex cytology). 3. Combination HPV and cytology testing (co-testing). 4. Cytology testing with HPV triage of positive cytology (reflex HPV). We addressed one contextual question that evaluated the efficacy of screening in women older than age 65 years according to the USPSTF's specified nonsystematic approach. The previous review addressed this question systematically, and the USPSTF recommended against routinely screening women older than age 65 years, based on limited evidence regarding the benefits of continued screening in these women. We did not update the direct evidence for screening in women after a hysterectomy because the prior USPSTF recommendation to discontinue screening after hysterectomy for benign disease is clearly supported. Because the HPV vaccine is so new, data to determine the long-term efficacy of the vaccine or how the HPV vaccine will affect screening is limited. Therefore, the USPSTF did not include a KQ addressing the impact of the HPV vaccine on cervical cancer screening.
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