Article Content

The U.S. Preventive Services Task Force (USPSTF) is an independent panel of experts in primary care and prevention that systematically reviews the evidence of effectiveness and rigorously evaluates clinical research in order to assess the merits of preventive measures, including screening tests, counseling, immunizations, and chemoprevention, and develops recommendations for clinical preventive services.

 

AJN has been publishing many of USPSTF's "Recommendations and Rationale" columns since 2001, and has included commentary on these recommendations from nurses in various specialties. Many more recommendations are published than AJN can accommodate, and so several are consolidated here. Complete information on which these recommendations are based is available through the USPSTF Web site (http://www.preventiveservices.ahrq.gov), through the National Guideline Clearinghouse (http://www.guideline.gov), and in print through the AHRQ Publications Clearing-house (call [800] 358-9295 or e-mail mailto:ahrqpubs@ahrq.gov).

 

Nurses should be aware that USPSTF evaluates research and bases its recommendations solely on that research-not on current clinical guidelines. If the research is inadequate, the USPSTF will not make recommendations.

 

Hepatitis B

The USPSTF strongly recommends screening for hepatitis B virus (HBV) infection in pregnant women at their first prenatal visit, as this substantially reduces prenatal transmission of HBV and the subsequent development of chronic HBV infection.

 

Hepatitis C

The USPSTF recommends against routine screening for hepatitis C virus (HCV) infection in asymptomatic adults who are not at increased risk for infection (general population), citing unnecessary biopsies and the fact that the prevalence of HCV infection in the general population is low; most who are infected do not develop cirrhosis or other major negative health outcomes.

 

Screening and Behavioral Counseling in Primary Care to Reduce Alcohol Misuse

The USPSTF recommends screening and behavioral counseling interventions to reduce alcohol misuse by adults, including pregnant women, in primary care settings. Such screening can accurately identify patients whose levels or patterns of alcohol consumption do not meet criteria for alcohol dependence, but places them at risk for increased morbidity and mortality. There is evidence that brief behavioral counseling interventions with follow-up produce small to moderate reductions in alcohol consumption that are sustained over six- to 12-month periods or longer.

 

Rh (D) Incompatibility

The USPSTF strongly recommends Rh (D) blood typing and antibody testing for all pregnant women during their first visit for pregnancy-related care. Intervention with Rh (D) immunoglobulin, as appropriate, prevents maternal sensitization and improves outcomes for newborns, as does postpartum Rh (D) immunoglobulin prophylaxis.

 

Primary Care Interventions to Prevent Low Back Pain in Adults

The USPSTF concludes that the evidence is insufficient to recommend the routine use of back-strengthening exercises to prevent low back pain in adults in primary care settings.

 

Oral Cancer

The USPSTF concludes that the evidence is insufficient to recommend routinely screening adults for oral cancer, in either high-risk adults (that is, those over the age of 50 who use tobacco) or average-risk adults because of the low incidence of oral cancer in the United States.

 

Asymptomatic Bacteriuria

The USPSTF strongly recommends screening for asymptomatic bacteriuria with urine culture for women 12 to 16 weeks pregnant, as this significantly reduces symptomatic urinary tract infections, low birth weight, and preterm delivery.

 

Bladder Cancer

The USPSTF recommends against routine screening for bladder cancer in adults. Many of the cancers detected by screening have a low tendency to progress to invasive disease, there is a relatively low overall prevalence of asymptomatic bladder cancer that would eventually lead to important clinical consequences, and there is limited evidence that early treatment of bladder cancer detected through screening improves long-term health outcomes.

 

Pancreatic Cancer

The USPSTF recommends against routine screening for pancreatic cancer in asymptomatic adults using abdominal palpation, ultrasonography, or serologic markers. There is no evidence that screening for pancreatic cancer is effective in reducing mortality because of the very low prevalence of pancreatic cancer, limited accuracy of available screening tests, the invasive nature of diagnostic tests, and poor treatment outcomes.

 

Testicular Cancer

The USPSTF recommends against routine screening for testicular cancer in asymptomatic adolescent and adult males, as there is a low prevalence of testicular cancer and current treatment interventions provide very favorable health outcomes.

 

Syphilis

The USPSTF strongly recommends that clinicians screen persons at increased risk for syphilis infection (for example, commercial sex workers) as well as pregnant women, even though there is no direct evidence that screening for syphilis infection leads to improved health outcomes in persons at increased risk). There is adequate evidence that screening can accurately detect syphilis infection and that antibiotics can cure syphilis.

 

Idiopathic Scoliosis in Adolescents

The USPSTF recommends against routine screening of asymptomatic adolescents for idiopathic scoliosis. The USPSTF did not find good evidence that screening asymptomatic adolescents detects idiopathic scoliosis at an earlier stage than detection without screening. Most cases detected through screening will not progress to a clinically significant form of scoliosis. Scoliosis needing aggressive treatment, such as surgery, is likely to be detected without screening.

 

AJN Wins Award