2017 Uspstf

Front 1

AAA Screening

Back 1

MEN 65-75 who have EVER smoked. - Level B

Front 2

Screening for abnormal blood glucose/DM2

Back 2

Anyone 40-70 years who is overweight or obese without other risk factors. Send to intensive behavioral counseling. - Level B

(Consider earlier screening if +family history, gestational diabetes, PCOS, or high risk ethnic groups)

Front 3

Alcohol screening and counseling

Back 3

18 and older (insufficient evidence for teenagers). Brief behavioral counseling for intervention. - Level B

(Note this guideline is currently being updated)

Front 4

Aspirin for prevention of CVD and colorectal cancer

Back 4

Age 50-59 with 10% or greater 10 year CVD risk score, no bleeding risk, 10 year life expectancy, and willing to take it for at least 10 years - Level B

(Age 60-69 is level C. Anything <50 or >70 level I)

Front 5

Screening for asymptomatic bacteriuria

Back 5

Pregnant women 12-16 weeks gestation ONLY. - Level A

Front 6

Autism screening 18-30 months

Back 6

No

(Insufficient evidence to screen unless concerns are raised by parents or clinician)

Front 7

Bacterial vaginosis screening in pregnancy

Back 7

Do NOT screen asymptomatic women. (Even those at HIGH RISK for preterm delivery has insufficient evidence).

Front 8

Bladder Cancer screening in adults

Back 8

NO

(Insufficient evidence to screen asymptomatic adults)

Front 9

HTN screening in children and adolescents

Back 9

No

(Insufficient evidence to screen asymptomatic pediatric patients. No evidence that screening reduces adverse cardiovascular outcomes in adulthood)

Front 10

BRCA assessment, counseling, and testing

Back 10

Several steps:

1) +Family history of breast, ovarian, tubal, or peritoneal cancer

2) Then use a screening tool

3) If positive refer to genetic counseling

4) If indicated after counseling THEN test for the gene. - Level B

Front 11

Breast Cancer medications for risk reduction

Back 11

SHARED decision making.

If high risk for cancer (but NO prior personal history of breast cancer) and low risk for adverse effects (No thromboembolic history) offer Tamoxifene (Age 35+) or Raloxifene (postmenopausal). - Level B

Front 12

Breast Cancer screening

Back 12

Biennial screening mammography 50-74 years of age. - Level B

(Ages 40-49 only if the woman wants it and values the benefits over the harms).

Front 13

Breastfeeding interventions by primary care

Back 13

YES! Provide interventions and support both during pregnancy and after birth. - Level B

Front 14

Carotid artery stenosis screening

Back 14

No!

(If asymptomatic then evidence is Level D in the general adult population)

Front 15

Cervical Cancer screening

Back 15

Pap smear every 3 years ages 21-65.

OR

Every 5 years ages 30-65 if done WITH HPV testing. - Level A

(Does not apply to women with prior cancer or high grade precancerous lesion, HIV, immunocompromised, DES exposure in utero)

Front 16

Child maltreatment interventions by PCP

Back 16

If no signs of abuse or maltreatment then insufficient evidence to perform any type of intervention

(Note that maltreatment, abuse, and neglect have different definitions)

Front 17

Chlamydia and Gonorrhea screening

Back 17

24 years and younger if at all sexually active. Older women if high risk. - Level B

(Insufficient evidence to screen men)

Front 18

CKD screening

Back 18

No

Not in asymptomatic adults. Insufficient evidence to screen.

(This does NOT include adults with HTN, DM, etc.)

Front 19

COPD screening

Back 19

No!

(Do NOT screen asymptomatic adults - Level D)

Front 20

Cognitive impairment screening in older adults

Back 20

No

Insufficient evidence

Front 21

Colorectal cancer screening

Back 21

Screen ages 50-75 using one of the approved methods and intervals. - Level A

(Ages 76-85 depend on risks and benefits, life expectancy, etc. Level C)

Front 22

Congenital hypothyroidism screening

Back 22

Defer to DACHDNC guidelines?

Front 23

CHD screening (using non traditional risk factors)

Back 23

Insufficient evidence to screen with non-traditional tools such as ABI, CRP, Calcification score, etc if patient is asymptomatic?

(Confusing guideline. Please correct me if I read this one wrong)

Front 24

CHD screening with ECG

Back 24

No!

(Do NOT screen asymptomatic adults at low risk with an ECG in order to evaluate CHD. - Level D)

Front 25

Dental and Periodontal Disease counseling

Back 25

Old recommendations are now INACTIVE. No USPSTF recommendations on this subject

Front 26

Screening for Dental Caries in children age 5 or less

Back 26

Provide oral fluoride supplementation starting at 6 months if none in water supply

PCP should apply fluoride varnish once 1st tooth erupts

- Level B

Front 27

Depression in adults screening

Back 27

Yes. Screen pregnant, postpartum, and general adult population. Make sure you have systems in place to appropriately treat them and follow up. - Level B

Front 28

Depression in children and adolescents screening

Back 28

Screen ages 12-18 for MDD with adequate systems in place to diagnose, treat, and follow up. - Level B

Front 29

Developmental hip dysplasia screening

Back 29

No.

Insufficient evidence to screen asymptomatic babies.

Front 30

Illicit drug use interventions for children and adolescents

Back 30

No

Insufficient evidence for any PCP behavioral intervention if they are not already diagnosed with a substance disorder.

Front 31

Illicit drug use screening

Back 31

No

Insufficient evidence to screen asymptomatic adults, adolescents, pregnant women

Front 32

Fall prevention in older adults

Back 32

Offer exercise or PT and Vit D supplementation to adults 65 years or older at increased risk of falls. (There is no good screening tool for this recommended). - Level B

(Do not just automatically do a comprehensive screening and assessment in older adults. Let the past history or comorbidities lead you. Level C)

Front 33

Folic Acid for prevention of neural tube defects

Back 33

YES!

ALL women capable of childbearing should take 0.4 to 0.8 mg folic acid daily. - Level A

Front 34

Genital Herpes screening

Back 34

No!

Do NOT routinely screen in asymptomatic adolescents, adults, or pregnant women. Level D

Front 35

Gestational Diabetes screening

Back 35

Screen asymptomatic women after 24 weeks gestation. - Level B

Front 36

Glaucoma screening

Back 36

No

Insufficient evidence to screen asymptomatic adults for open angle glaucoma

Front 37

Gynecologic cancers counseling

Back 37

Now inactive. No guidelines from USPSTF

Front 38

Diet and physical activity counseling in adults with CVD risk factors

Back 38

Offer or refer all overweight or obese adults with other CVD risk factors to intensive behavioral counseling.

Front 39

Diet and physical activity counseling in adults not at high risk

Back 39

Behavioral counseling on diet and exercise has little benefit in this population. - Level C

Front 40

Hearing loss screening in newborns

Back 40

Inactive. No guidelines from USPSTF

Front 41

Hearing loss in older adults screening

Back 41

No

Insufficient evidence to screen asymptomatic adults older than age 50

Front 42

Hemochromatosis screening

Back 42

Inactive. No USPSTF guidelines

Front 43

Hep B screening in pregnant women

Back 43

Yes!

Screen at first prenatal visit

Front 44

Hep B screening

Back 44

Screen people at high risk for infection (hemodialysis, immunocompromised, not vaccinated, etc). - Level B

Front 45

Hep C screening

Back 45

Screen those at high risk (incarceration, tattoos, IV drug use, blood transfusion before 1992, etc) and one time for anyone born between 1945-1965. - Level B

Front 46

HTN in adults screening

Back 46

Screen adults 18 and over. Get readings outside the clinic setting for confirmation before starting treatment if possible. - Level A

Front 47

HIV screening

Back 47

Yes! Screen ages 15-65, pregnant women, and anyone else at high risk. - Level A

(Note that screening intervals can vary according to risk. No set recommendation. 1 year if high risk, 3-5 if low risk is decent).

Front 48

Hyperbilirubinemia screening in infants

Back 48

Inactive. No USPSTF recommendations

Front 49

Screening for idiopathic scoliosis in adolescents

Back 49

No!

Do NOT screen asymptomatic adolescents.

Level D

Front 50

Immunizations for adults

Back 50

Defer to CDC guidelines

Front 51

Immunizations for children

Back 51

Defer to CDC guidelines

Front 52

Impaired visual acuity screening in older adults

Back 52

No.

Insufficient evidence in asymptomatic adults

Front 53

Screening for intimate partner violence and abuse of the elderly/vulnerable

Back 53

Screen women of childbearing age and provide or refer for intervention. - Level B

(Insufficient evidence to screen asymptomatic elderly or vulnerable adults).

Front 54

Screening and supplementation for iron deficiency anemia in pregnancy

Back 54

No

Insufficient evidence to routinely screen or supplement iron during pregnancy

Front 55

Iron deficiency anemia screening in young children

Back 55

Insufficient evidence in 6-24 months

Front 56

Latent TB infection screening

Back 56

Screen in at risk populations (immunocompromised, prisons, homeless, some foreign countries, etc). - Level B

(Note that USPSTF does not make recommendations on screening medical providers)

Front 57

Lead level screening in childhood and pregnancy

Back 57

No!

Do not screen asymptomatic children ages 1-5 or pregnant women. - Level D

(Even children at high risk have insufficient evidence for screening if asymptomatic).

Front 58

Lipid disorder screening in children and adolescents

Back 58

No

Insufficient evidence to screen anyone 20 years of age or younger

Front 59

Low dose aspirin to prevent morbidity and mortality in preeclampsia

Back 59

Yes, give 81mg aspirin daily after 12 weeks gestation in women at high risk (previous preeclampsia, multigestation, HTN, DM 1 or 2, renal disease, autoimmune disease) for preeclampsia. - Level B

Front 60

Lung cancer screening

Back 60

Annual low dose CT screening in people 55-80 with 30 pack year history who are currently smoking or quit in the past 15 years.

(Unless unable to even have lung surgery due to poor health or unwillingness). - Level B

Front 61

Menopausal horomone preventative therapy

Back 61

No!

Do NOT use estrogen or combination medicine for prevention of chronic disease in asymptomatic postmenopausal women. Level D

(Does not apply to women <50 with menopause 2/2 surgery)

Front 62

Motor vehicle restraints counseling

Back 62

Refer to CDC community guide

Front 63

Obesity in adults - screening and management

Back 63

Screen all adults for obesity. BMI 30 or higher need intensive multicomponent behavioral interventions. - Level B

Front 64

Obesity screening in children and adolescents

Back 64

Screen children age 6 and older and offer or refer to comprehensive, intensive behavioral intervention.

Front 65

OSA screening in adults

Back 65

No

Insufficient evidence to screen asymptomatic adults for OSA.

Front 66

Neonatal ocular gonorrhea prevention

Back 66

Yes!

Prophylactic topical ocular treatment ALL newborns. - Level A

Front 67

Oral cancer screening

Back 67

No

Insufficient evidence to screen asymptomatic adults.

Front 68

Osteoporosis screening

Back 68

Yes, screen women 65 years and older as well as women whose fracture risk is equal to or greater than an otherwise healthy 65 year old woman (that is to say a 9.3% 10 year risk). - Level B

(insufficient evidence to screen men)

Front 69

Ovarian cancer screening

Back 69

No!

Do NOT screen asymptomatic women for ovarian cancer. - Level D

Front 70

Pancreatic cancer screening

Back 70

No!

Do NOT screen asymptomatic adults (this includes abdominal palpation, US, or serologic markers). - Level D

Front 71

CVD and PAD risk assessment in adults with ABI

Back 71

No

Insufficient evidence to screen for these via ABI

Front 72

Phenylketonuria screening in newborns

Back 72

Refer to DACHDNC guidelines

Front 73

Preeclampsia screening

Back 73

No recommendations

Front 74

Prostate cancer screening

Back 74

No!

Do NOT screen with a PSA. - Level D

Front 75

RhD incompatability screening

Back 75

Blood typing and antibody testing during first prenatal visit. - Level A

Repeat antibody testing at 24-28 weeks gestation for all unsensitized RhD negative women unless father is KNOWN to be RhD negative. - Level B

Front 76

Rubella immunization

Back 76

Refer to CDC guidelines

Front 77

Rubella screening

Back 77

Inactive. No USPSTF guideline

Front 78

STI behavioral counseling

Back 78

Yes, intensive behavioral counseling for all sexually active adolescents and adults at increased risk for STIs. - Level B

Front 79

Sickle Cell Disease screening in newborns

Back 79

Refer to DACHDNC

Front 80

Skin cancer counseling

Back 80

Counsel everyone 10-24 years of age with fair skin about minimizing UV radiation. - Level B

(Insufficient evidence >24 years of age)

Front 81

Skin cancer screening

Back 81

Insufficient evidence for visual skin exam by a clinician

Front 82

Speech and language delay screening in children age 5 and younger

Back 82

Insufficient evidence to screen this population

Front 83

Statin use for prevention of CVD

Back 83

Give a low-moderate dose statin to adults 40-75 with no history of CVD, 1 or more risk factors, and 10 year risk score of 10% or greater. Level B

(risk score of 7.5-10% is Level C evidence. Insufficient evidence for people > 75 years of age)

Front 84

Suicide risk screening

Back 84

No

Insufficient evidence to screen asymptomatic adolescents, adults, or elderly in a primary care setting.

Front 85

Syphilis screening in the non pregnant population

Back 85

Yes, screen those at increased risk (HIV + and men who have sex with men especially). - Level A

Front 86

Syphilis screening in pregnancy

Back 86

Yes, screen all pregnant women. - Level A

Front 87

Testicular cancer screening

Back 87

No!

Do NOT screen adolescent or adult men. Level D

Front 88

Thyroid cancer screening

Back 88

No Current recommendations (this is currently being updated)

Front 89

Thyroid dysfunction screening

Back 89

No

Insufficient evidence to screen in asymptomatic, non pregnant adults.

Front 90

Tobacco smoking cessation in adults

Back 90

Ask ALL adults about smoking, advise on cessation, and provide behavioral counseling as well as FDA approved pharmocotherapy.

In pregnant women do the same except for pharmacotherapy. - Level A

(Insufficient evidence to give pregnant women pharmacotherapy or to recommend electronic nicotine systems to anyone)

Front 91

Tobacco use in children and adolescents intervention

Back 91

Yes, provide education, brief counseling, or other interventions to PREVENT initiation of tobacco in school aged children. - Level B

Front 92

Visual impairment screening in ages 3-5

Back 92

Yes, screen at least once between ages 3-5 to detect amblyobia or its risk factors. - Level B

(insufficient evidence < 3 years of age)

Front 93

Vit D and Calcium to prevent fractures

Back 93

As noted previously, give to adults >65 at increased risk for falls. - Level B

For everyone else evidence rating is I or even D so don't do it for primary prevention.

Front 94

Vit D deficiency screening

Back 94

No

Insufficient evidence to screen asymptomatic adults.

Front 95

Vitamin supplementation to prevent cancer and CVD

Back 95

No!

Beta carotene and Vit E are Level D!

Everything else has insufficient evidence

Front 96

Youth violence counseling

Back 96

Refer to CDC community guide