Adults
Age 18+ by asking about tobacco use, advise them to stop using tobacco, and provide behavioral interventions and U.S. Food and Drug Administration (FDA)–approved pharmacotherapy for cessation to adults who use tobacco (includes pregnant women).
Age 18+ for Obesity: BMI > 30. Initiate "intensive, multicomponent behavioral interventions." if positive.
Age 18+ for High BP.
for Syphilis infection in persons who are at increased risk for infection.
Age 40-70 and Overweight for Diabetes with fasting blood glucose test.
Colonoscopy:
Every 3-10 years age 50-75 depending on findings of colonoscopy.
Start at age 40 if a 1st degree relative had colon cancer after age 50. Start ten years earlier than diagnosis if 1st degree relative had colon cancer earlier than age 50.
Older than 75 to 85 is at individual discretion. More likely to benefit if never before screened.
All adults
Adult Smokers
AAA:
One time Abdominal US Screening between age 65 and 75 in men who have ever smoked.
Lung cancer screening with Low Dose Computed Tomography (LDCT) in age 55-80 if smoked (>30 pack-years) and quit less than 15 years ago. Discontinue after 15 years abstinence or if unwilling to do surgery if positive.
Alcohol misuse:
Screen those 18+
Initiate low dose ASA preventive medication against CVD and C/R cancer
for those 50-59 with a 10%+ 10 year risk. Evidence is only grade C for those 60-69.
Depression Screening 19 and up, for MDD age 12-18.
Vit D supplementation and exercise for community dwelling older adults 65+ at risk for fall.
If overweight or obese, refer for or perform intensive behavioral intervention. Counselling shows small benefit in ordinary patients.
Latent TB in those at high risk: PPD test
Test Hep B in those at high risk.
Test Hep C in those at high risk and those born between 1945 and 1965.
Selectively offer AAA US screening between 65-75 in non-smokers.
Vaccinations:
Pneumonia Vax (Antigen)
For naive immunocompetent: 19-64yo: give one dose of PPSV23 (and no more for a year if 64yo).
65 and older: Prevnar (PCV13) then Pneumovax (PPSV23) a year later and at least 5 years after most recent PPSV23.
If received dose of PPSV23 already, give Prevnar (PCV13) a year later.
For non-competent: Give Prevnar (PCV13) between 19-64.
Tetanus Vax (Tdap antigen). Every 10 years. Repeat if more than 5 years and unsure.
Flu Vax: Annual (Killed)
Women
Childbearing-age women take 0.4 to 0.8 mg Folate (if preg possible)
and Screen for intimate partner abuse.
Pregnant:
The USPSTF recommends that clinicians screen all pregnant women for syphilis infection.
Hep B: first prenatal visit.
Rh(D) blood typing and antibody testing: first prenatal visit.
Asymptomatic Bacteriuria:
between 12 and 16 weeks.
Gestational Diabetes after 24 weeks.
The USPSTF recommends repeated Rh(D) antibody testing for all unsensitized Rh(D)-negative women at 24 to 28 weeks' gestation, unless the biological father is known to be Rh(D)-negative.
For women at high risk for pre-eclampsia: 81 mg/d ASA after 12 weeks.
Pap Smear
Age 21-29: Every 3 years get a pap smear for screening cervical cancer
30-65: Combined cytology, HPV and pap smear every 5 years
Mammography:
age 40-49: less clear cut evidence for biennial screening. Family history could justify.
Biennially age 50-74. American college of surgeons say annually is justified. And insurance will pay for annual even from age 40.
BRCA-related cancers (breast, ovarian, tubal or peritoneal) in 1st degree relative should be screened for gene.
Women at high risk for breast cancer:
should be offered tamoxifen or raloxifene to mitigate risk.
Ghonnorrhea and Chlamydia Screening
For sexually active women under age of 24 and "at risk" older women.
Lipid levels age 20 and older if at increased risk for coronary artery disease.
Osteoporosis: Age 65 and older and those women with equivalent risk. DEXA. -1 and less: osteopenic. -2.5 SD and less osteoporotic.
Men
PSA:
Start talking about it at age 50. Rectal exam poor evidence. Give it to them if they ask.
Lipid levels starting at age 35, age 20-35 if at increased risk for coronary artery disease.
Children
Newborns: "The USPSTF recommends prophylactic ocular topical medication for all newborns for the prevention of gonococcal ophthalmia neonatorum. "
Oral fluoride supplementation and lining for those without fortified water or abscess resp.
The USPSTF recommends vision screening for all children at least once between the ages of 3 and 5 years, to detect the presence of amblyopia or its risk factors.
Screen age 6 and up for obesity.
Sexually active adolescents: The USPSTF recommends intensive behavioral counseling for all sexually active adolescents and for adults who are at increased risk for sexually transmitted infections (STIs).
Fair skinned adolescents: counsel avoiding direct sun exposure, using sunblock.
Source
Smokers: The USPSTF recommends that primary care clinicians provide interventions, including education or brief counseling, to prevent initiation of tobacco use among school-aged children and adolescents.
*according to the USPSTF (United States Preventive Screening Task Force)
Variant words: Abdominal U/S Abdominal Ultrasound
No comments:
Post a Comment