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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_2866_Библиотеки_им_академика_М_И_Перельмана.pdf
Chapter 1. Screening/Physical Exam/Health…
11
provide patients with health improvement education and options
strategies that are acceptable to the patient, such as adding exercise intervals or
incorporating fresh produce into their diets
• Providers support their patients in developing plans to implement health- promoting
4. Autonomy • In working with overweight patients, providers might assess readiness to lose weight and
other clinical markers is seen as success
• For patients who overeat, healthy eating is viewed as an ongoing, gradual process
• For patients who are interested in losing weight, weight gain is not seen as failure but as
5. Incrementalism • For the obese patient, any weight loss, increase in physical activity, or improvement in
part of the process
they regularly eat foods with high- sugar content
• Patients who are overweight and have diabetes continue to receive insulin even though
• Patients who are obese are not terminated from care if they continue to gain weight
without
termination
6. Accountability
12
J. Conigliaro and S. Kapoor
Decision-Making/Differential Diagnosis
Screening
The utilization of sensitive and specific screening tools can
serve to guide the decision-making process and the formulation of differential diagnoses. Screenings are utilized to help
identify early-stage disease processes where early identification and treatment have been demonstrated to improve outcomes. Safety, risk, cost-effectiveness, and predictive value
need to be considered when deciding which screenings are to
be conducted in which populations.
Screening is constant throughout the care of the patient.
The action of screening exists while co-constructing a history,
while conducting a physical exam and beyond a visit when
reviewing laboratory results. Clinicians are charged with
investigating relevant nuggets of information that may align
with an illness profile, and to satisfy this expectation, they
need to arm themselves with screening tools that can facilitate the process.
The US Preventive Services Task Force (USPSTF) is an
independent panel of experts in primary care and prevention
[8]. This panel systematically reviews the literature for evidence of effectiveness and develops recommendations for
clinical preventive services. The USPSTF highlights over 45
“A-” and “B-” rated recommendations based on a patient’s
gender, age, and certain risk factors (Table1. 3 ) [9]. The task
force assigns one of five letter grades (A, B, C, D, or I) to each
recommendation based on the evidence of effectiveness
(Table 1.4) [10]. These recommendations are updated
periodically.
Clinicians are accustomed to a multitude of evidencebased screenings that are already part of the usual clinical
care (e.g., blood pressure, weight, HbA1c, hepatitis, HIV testing, etc.). In addition, the USPSTF and other similar panels
make recommendations for screening for behavioral conditions and risky behaviors such as depression [11], sedentary
lifestyle, and alcohol use [12]. These recommendations
Chapter 1. Screening/Physical Exam/Health…
13
a
Release date of
current
recommendation
B December 2019
a
a
B April 2016
B September 2021
(continued)
The USPSTF recommends one- time screening
for abdominal aortic aneurysm (AAA) with
ultrasonography in men aged 65–75years who have ever
smoked
The USPSTF recommends initiating low- dose aspirin
use for the primary prevention of cardiovascular disease
(CVD) and colorectal cancer (CRC) in adults aged
50–59years who have a 10% or greater 10-year CVD
risk, are not at increased risk for bleeding, have a life
expectancy of at least 10years, and are willing to take
low-dose aspirin daily for at least 10years
The USPSTF recommends the use of low-dose aspirin
(81mg/day) as preventive medication after 12weeks
of gestation in persons who are at high risk for
preeclampsia. See the Practice Considerations section
for information on high risk and aspirin dose
Topic Description Grade
Abdominal aortic aneurysm:
screening: men aged
65–75years who have ever
smoked
Aspirin use to prevent
cardiovascular disease and
colorectal cancer: preventive
medication: adults aged
50–59years with a 10% or
greater 10-year CVD risk
Aspirin use to prevent
preeclampsia and related
morbidity and mortality:
preventive medication:
pregnant persons at high
T . USPSTF “A-” and “B-” rated recommendations [9]
risk for preeclampsia
14
J. Conigliaro and S. Kapoor
a
Release date of
current
recommendation
B September 2019
a
a
B August 2019
B September 2019
T . (continued)
Topic Description Grade
The USPSTF recommends screening for asymptomatic
bacteriuria using urine culture in pregnant persons
The USPSTF recommends that primary care clinicians
assess women with a personal or family history of breast,
ovarian, tubal, or peritoneal cancer or who have an
ancestry associated with breast cancer susceptibility 1
and 2 (BRCA1/2) gene mutations with an appropriate
brief familial risk assessment tool. Women with a
Asymptomatic bacteriuria
in adults: screening:
pregnant persons
BRCA-related cancer:
risk assessment, genetic
counseling, and genetic
testing: women with a
personal or family history
of breast, ovarian, tubal,
positive result on the risk assessment tool should receive
genetic counseling and, if indicated after counseling,
genetic testing
The USPSTF recommends that clinicians offer to
prescribe risk-reducing medications, such as tamoxifen,
raloxifene, or aromatase inhibitors, to women who are
at increased risk for breast cancer and at low risk for
adverse medication effects
or peritoneal cancer or an
ancestry associated with
brca1/2 gene mutation
Breast cancer: medication
use to reduce risk: women
at increased risk for breast
cancer aged 35years or
older
Chapter 1. Screening/Physical Exam/Health…
15
a
a
B January 2016
B October 2016
a
A August 2018
a
(continued)
B September 2021
The USPSTF recommends biennial screening
mammography for women aged 50–74years
The USPSTF recommends providing interventions
during pregnancy and after birth to support
Breast cancer: Sscreening:
women aged 50–74years
Breastfeeding: primary care
interventions: pregnant
breastfeeding
The USPSTF recommends screening for cervical cancer
every 3years with cervical cytology alone in women
aged 21–29years. For women aged 30–65years, the
USPSTF recommends screening every 3years with
women, new mothers, and
their children
Cervical Cancer: Screening:
women aged 21–65years
cervical cytology alone, every 5years with high-risk
human papillomavirus (hrHPV) testing alone, or every
5years with hrHPV testing in combination with cytology
(cotesting). See the Clinical Considerations section for
the relative benefits and harms of alternative screening
strategies for women 21years or older
The USPSTF recommends screening for gonorrhea in
all sexually active women 24years or younger and in
women 25years or older who are at increased risk for
infection
Chlamydia and gonorrhea:
Sscreening: sexually active
women, including pregnant
persons
16
J. Conigliaro and S. Kapoor
a
Release date of
current
recommendation
a
a
a
B September 2021
The USPSTF recommends screening for chlamydia in
all sexually active women 24years or younger and in
B May 2021
women 25years or older who are at increased risk for
infection
The USPSTF recommends screening for colorectal
cancer in adults aged 45–49years. See the “"Practice
Considerations” section and Table1.1 for details about
screening strategies
A May 2021
The USPSTF recommends screening for colorectal
cancer in all adults aged 50–75years. See the “"Practice
Considerations” section and Table1.1 for details about
screening strategies
B January 2016
The USPSTF recommends screening for depression in
the general adult population, including pregnant and
postpartum women. Screening should be implemented
with adequate systems in place to ensure accurate
diagnosis, effective treatment, and appropriate follow-up
T . (continued)
Topic Description Grade
Chlamydia and gonorrhea:
screening: sexually active
women, including pregnant
persons
Colorectal cancer: screening:
adults aged 45–49years
Colorectal cancer:
Sscreening: adults aged
50–75years
Depression in adults:
screening: general adult
population, including
pregnant and postpartum
women
Chapter 1. Screening/Physical Exam/Health…
17
a
a
B February 2016
B April 2018
a
A January 2017
a
(continued)
B August 2021
The USPSTF recommends screening for major
depressive disorder (MDD) in adolescents aged
12–18years. Screening should be implemented with
adequate systems in place to ensure accurate diagnosis,
effective treatment, and appropriate follow-up
The USPSTF recommends exercise interventions to
prevent falls in community-dwelling adults 65years or
older who are at increased risk for falls
The USPSTF recommends that all women who
Depression in children
and adolescents: screening:
adolescents aged
12–18years
Falls prevention in
community-dwelling older
adults: interventions: adults
65years or older
Folic acid for the prevention
are planning or capable of pregnancy take a daily
supplement containing 0.4–0.8mg (400–800μg) of folic
acid
of neural tube defects:
preventive medication:
women who are planning or
The USPSTF recommends screening for gestational
diabetes in asymptomatic pregnant persons at 24weeks
of gestation or after
capable of pregnancy
Gestational diabetes:
screening: asymptomatic
pregnant persons at
24weeks of gestation or
after
18
J. Conigliaro and S. Kapoor
a
Release date of
current
recommendation
B November 2020
B May 2021
a
B December 2020
T . (continued)
Topic Description Grade
The USPSTF recommends offering or referring adults
with cardiovascular disease risk factors to behavioral
counseling interventions to promote a healthy diet and
physical activity
Healthy diet and physical
activity for cardiovascular
disease prevention in
adults with cardiovascular
risk factors: behavioral
counseling interventions:
The USPSTF recommends that clinicians offer pregnant
adults with cardiovascular
disease risk factors
Healthy weight and
persons effective behavioral counseling interventions
aimed at promoting healthy weight gain and preventing
excess gestational weight gain in pregnancy
The USPSTF recommends screening for hepatitis
B virus (HBV) infection in adolescents and adults
at increased risk for infection. See the Practice
Considerations section for a description of adolescents
and adults at increased risk for infection
weight gain in pregnancy:
behavioral counseling
interventions: pregnant
persons
Hepatitis B virus infection
in adolescents and adults:
screening: adolescents and
adults at increased risk for
infection
Chapter 1. Screening/Physical Exam/Health…
19
a
A July 2019
a
B March 2020
a
A June 2019
a
A June 2019
(continued)
The USPSTF recommends screening for hepatitis B
virus (HBV) infection in pregnant women at their first
prenatal visit
The USPSTF recommends screening for hepatitis C
virus (HCV) infection in adults aged 18–79years
Hepatitis B virus infection
in pregnant women:
screening: pregnant women
Hepatitis C virus infection
in adolescents and adults:
The USPSTF recommends that clinicians screen for HIV
Sscreening: adults aged
18–79years
Human immunodeficiency
infection in adolescents and adults aged 15–65years.
Younger adolescents and older adults who are at
increased risk of infection should also be screened. See
the Clinical Considerations section for more information
about assessment of risk, screening intervals, and
virus (HIV) infection:
screening: adolescents and
adults aged 15–65years
rescreening in pregnancy
The USPSTF recommends that clinicians screen for
HIV infection in all pregnant persons, including those
Human immunodeficiency
virus (HIV) infection:
who present in labor or at delivery whose HIV status is
unknown
screening: pregnant persons
20
J. Conigliaro and S. Kapoor
a
Release date of
current
recommendation
a
a
A April 2021
The USPSTF recommends screening for hypertension
in adults 18years or older with office blood pressure
measurement (OBPM). The USPSTF recommends
obtaining blood pressure measurements outside of
the clinical setting for diagnostic confirmation before
starting treatment
B October 2018
The USPSTF recommends that clinicians screen
for intimate partner violence (IPV) in women of
reproductive age and provide or refer women who
screen positive to ongoing support services. See the
Clinical Considerations section for more information
on effective ongoing support services for IPV and for
information on IPV in men
B September 2016
The USPSTF recommends screening for latent
tuberculosis infection (LTBI) in populations at increased
risk
T . (continued)
Topic Description Grade
Hypertension in adults:
screening: adults 18years
or older without known
hypertension
Intimate partner violence,
elder abuse, and abuse of
vulnerable adults: screening:
women of reproductive age
Latent tuberculosis
infection: screening:
asymptomatic adults at
increased risk for infection