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US Preventive Services Task Force. Guide to Clinical Preventive Services: Report of the U.S. Preventive Services Task Force. 2nd edition. Baltimore (MD): Williams & Wilkins; 1996.

  • This publication is provided for historical reference only and the information may be out of date.

This publication is provided for historical reference only and the information may be out of date.

Cover of Guide to Clinical Preventive Services

Guide to Clinical Preventive Services: Report of the U.S. Preventive Services Task Force. 2nd edition.

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Appendix A Task Force Ratings

The tables of ratings on the following pages were developed for the U.S. Preventive Services Task Force using the methodology adapted from the Canadian Task Force on the Periodic Health Examination [a] and described in Chapter ii. For this edition of the Guide, the Task Force developed ratings for all of the topics examined.

The Task Force graded the strength of recommendations for or against preventive interventions as follows.

Strength of Recommendations

A: There is good evidence to support the recommendation that the condition be specifically considered in a periodic health examination.
B: There is fair evidence to support the recommendation that the condition be specifically considered in a periodic health examination.
C: There is insufficient evidence to recommend for or against the inclusion of the condition in a periodic health examination, but recommendations may be made on other grounds.
D: There is fair evidence to support the recommendation that the condition be excluded from consideration in a periodic health examination.
E: There is good evidence to support the recommendation that the condition be excluded from consideration in a periodic health examination.

Determination of the quality of evidence (i.e., "good," "fair," "insufficient") in the strength of recommendations was based on a systematic consideration of three criteria: the burden of suffering from the target condition, the characteristics of the intervention, and the effectiveness of the intervention as demonstrated in published clinical research. Effectiveness of the intervention received special emphasis. In reviewing clinical studies, the Task Force used strict criteria for selecting admissible evidence and placed emphasis on the quality of study designs. In grading the quality of evidence, the Task Force gave greater weight to those study designs that, for methodologic reasons, are less subject to bias and inferential error. The following rating system was used.

Quality of Evidence

I: Evidence obtained from at least one properly randomized controlled trial.
II-1: Evidence obtained from well-designed controlled trials without randomization.
II-2: Evidence obtained from well-designed cohort or case-control analytic studies, preferably from more than one center or research group.
II-3: Evidence obtained from multiple time series with or without the intervention. Dramatic results in uncontrolled experiments (such as the results of the introduction of penicillin treatment in the 1940s) could also be regarded as this type of evidence.
III: Opinions of respected authorities, based on clinical experience descriptive studies and case reports or reports of expert committees.

Well-designed and well-conducted meta-analyses were also considered, and were graded according to the quality of the studies on which the analyses were based (e.g., Grade I if the meta-analysis pooled properly randomized controlled trials).

An exact correlation does not exist between the strength of the recommendation and the level of evidence, i.e., Level I evidence did not necessarily lead to an "A" grade, nor did an "A" grade require Level I evidence. For example, there may have been evidence of good quality that did not prove that an intervention is effective (e.g., mammography in women under age 50, which received a "C" recommendation). On the other hand, an "A" recommendation was given to screening for cervical cancer with Papanicolaou testing, based on burden of suffering and Level II evidence supporting the effectiveness of the intervention. For many preventive services, there is insufficient evidence to determine whether or not routine intervention will improve clinical outcomes ("C" recommendation). A variety of different circumstances can result in a "C" recommendation: available studies are not adequate to determine effectiveness (e.g., insufficient statistical power, unrepresentative populations, lack of clinically important endpoints, or other important design flaws) high-quality studies have produced conflicting results evidence of significant benefits is offset by evidence of important harms from intervention or studies of effectiveness have not been conducted. As a result, lack of evidence of effectiveness does not constitute evidence of ineffectiveness. Chapter ii provides further information about the methodology used to develop the body of this report.

Table 1. Screening for Asymptomatic Coronary Artery Disease

Table 2. Screening for High Blood Cholesterol and Other Lipid Abnormalities

Table 3. Screening for Hypertension

Table 4. Screening for Asymptomatic Carotid Artery Stenosis

Table 5. Screening for Peripheral Arterial Disease

Table 6. Screening for Abdominal Aortic Aneurysm

Table 7. Screening for Breast Cancer

Table 8. Screening for Colorectal Cancer

Table 9. Screening for Cervical Cancer

Table 10. Screening for Prostate Cancer

Table 11. Screening for Lung Cancer

Table 12. Screening for Skin Cancer---Including Counseling to Prevent Skin Cancer

Table 13. Screening for Testicular Cancer

Table 14. Screening for Ovarian Cancer

Table 15. Screening for Pancreatic Cancer

Table 16. Screening for Oral Cancer

Table 17. Screening for Bladder Cancer

Table 18. Screening for Thyroid Cancer

Table 19. Screening for Diabetes Mellitus

Table 20. Screening for Thyroid Disease

Table 21. Screening for Obesity

Table 22. Screening for Iron Deficiency Anemia—Including Iron Prophylaxis

Table 23. Screening for Elevated Lead Levels in Childhood and Pregnancy

Table 24. Screening for Hepatitis B Virus Infection

Table 25. Screening for Tuberculous Infection—Including BCG Immunization

Table 26. Screening for Syphilis

Table 27. Screening for Gonorrhea—Including Ocular Prophylaxis in Newborns

Table 28. Screening for Human Immunodeficiency Virus Infection

Table 29. Screening for Chlamydial Infection—Including Ocular Prophylaxis in Newborns

Table 30. Screening for Genital Herpes Simplex

Table 31. Screening for Asymptomatic Bacteriuria

Table 32. Screening for Rubella—Including Immunization of Adolescents and Adults

Table 33. Screening for Visual Impairment

Table 34. Screening for Glaucoma

Table 35. Screening for Hearing Impairment

Table 36. Screening Ultrasonography in Pregnancy

Table 37. Screening for Preeclampsia

Table 38. Screening for D (Rh) Incompatibility

Table 39. Intrapartum Electronic Fetal Monitoring

Table 40. Home Uterine Activity Monitoring

Table 41. Screening for Down Syndrome

Table 42. Screening for Neural Tube Defects—Including Folate Prophylaxis

Table 43. Screening for Hemoglobinopathies

Table 44. Screening for Phenylketonuria

Table 45. Screening for Congenital Hypothyroidism

Table 46. Screening for Postmenopausal Osteoporosis

Table 47. Screening for Adolescent Idiopathic Scoliosis

Table 48. Screening for Dementia

Table 49. Screening for Depression

Table 50. Screening for Suicide Risk

Table 51. Screening for Family Violence

Table 52. Screening for Problem Drinking

Table 53. Screening for Drug Abuse

Table 54. Counseling to Prevent Tobacco Use

Table 55. Counseling to Promote Physical Activity

Table 56. Counseling to Promote a Healthy Diet

Table 57. Counseling to Prevent Motor Vehicle Injuries

Table 58. Counseling to Prevent Household and Recreational Injuries

Table 59. Counseling to Prevent Youth Violence

Table 60. Counseling to Prevent Low Back Pain

Table 61. Counseling to Prevent Dental and Periodontal Disease

Table 62. Counseling to Prevent HIV Infection and Other Sexually Transmitted Diseases

Table 63. Counseling to Prevent Unintended Pregnancy

Table 64. Counseling to Prevent Gynecologic Cancers

Table 65. Childhood Immunizations[1]

Table 66. Adult Immunizations—Including Chemoprophylaxis Against Influenza A

Table 67. Postexposure Prophylaxis for Selected Infectious Diseases

Table 68. Postmenopausal Hormone Prophylaxis

Table 69. Aspirin Prophylaxis for the Primary Prevention of Myocardial Infarction

Table 70. Aspirin Prophylaxis in Pregnancy

Footnotes

[a]

Canadian Task Force on the Periodic Health Examination. The periodic health examination. Can Med Assoc J 1979121:1193-1254.

[*]

See relevant chapter for definition of high risk.

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