The U.S. Preventive Services Task Force (USPSTF), an independent panel of experts in primary care and prevention, systematically reviews 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, so several are consolidated here for nurses to access. 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 [email protected]).

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.

Breastfeeding

There is fair evidence that programs performed by specially trained nurses or lactation specialists, combining breastfeeding education with behaviorally oriented counseling, are associated with increased rates of breastfeeding initiation and its continuation for up to three months, although effects beyond three months are uncertain. Effective programs generally involved at least one extended session, followed structured protocols, and included practical, behavioral skills training and problem solving in addition to didactic instruction.

Coronary Heart Disease

The USPSTF found insufficient evidence to recommend for or against routine scanning using the resting electrocardiography, exercise treadmill test, or electron-beam computerized tomographic scanning for coronary calcium for either the presence of severe coronary artery stenosis or the prediction of coronary heart disease events in adults at low risk for these events. The USPSTF believes that harms from false-positive tests (for example, unnecessary invasive procedures, overtreatment, and labeling) exceed the potential benefits.

Family and Intimate Partner Violence

The USPSTF found insufficient evidence to recommend for or against routine screening of parents or guardians for the physical abuse or neglect of children, of women for intimate partner violence, or of older adults or their caregivers for elder abuse.

Gestational Diabetes Mellitus

The USPSTF found fair to good evidence that screening combined with diet and insulin therapy can reduce the rate of fetal macrosomia in women with gestational diabetes mellitus. The USPSTF found insufficient evidence, however, that screening for gestational diabetes substantially reduces important adverse health outcomes for mothers or their infants (for example, cesarean delivery, birth injury, or neonatal morbidity or mortality), even though screening can produce frequent false-positive results.

High Blood Pressure

The USPSTF strongly recommends that clinicians screen adults ages 18 and older for high blood pressure. The USPSTF found good evidence that blood pressure measurement can identify adults at increased risk for cardiovascular disease resulting from high blood pressure and that treatment of high blood pressure substantially decreases the incidence of cardiovascular disease and causes little major harm. The USPSTF concludes the benefits of screening for, and treating, high blood pressure in adults substantially outweigh the harms.

Lung Cancer

The USPSTF concludes that there is insufficient evidence to recommend for or against screening asymptomatic persons for lung cancer with either low-dose computerized tomography, chest X-ray, sputum cytology, or a combination of these tests. Although screening with such tests can detect lung cancer at an earlier stage than lung cancer would otherwise be detected, the invasive nature of diagnostic testing and the possibility of a high number of false-positive tests create the potential for significant harms.

Obesity

The USPSTF recommends that clinicians screen all adult patients for obesity and offer counseling to promote sustained weight loss for obese adults, concluding that the evidence is insufficient to recommend for or against the use of moderate- or low-intensity counseling together with behavioral interventions to promote sustained weight loss in obese adults.

Ovarian Cancer

The USPSTF recommends against routine screening for ovarian cancer but found fair evidence that screening by checking serum CA-125 level or by transvaginal ultrasonography can detect ovarian cancer at an earlier stage than it can be detected in the absence of screening, even though this would likely have a small effect at best on deaths from ovarian cancer.

Skin Cancer

The USPSTF concludes that the evidence is insufficient to recommend for or against routine counseling by primary care clinicians to prevent skin cancer and whether clinician counseling is effective in changing patient behaviors to reduce skin cancer risk.

Thyroid Disease

The USPSTF concludes the evidence is insufficient to recommend for or against routine screening for thyroid disease in adults. The thyroid-stimulating hormone test can detect subclinical thyroid disease in people without symptoms of thyroid dysfunction, but there is poor evidence that shows that treatment improves clinically important outcomes in adults.

Visual Impairment in Children Younger than Five Years

The USPSTF recommends screening to detect amblyopia, strabismus, and defects in visual acuity in children younger than five years. Such screening has reasonable accuracy in identifying strabismus, amblyopia, and refractive error in children with these conditions; more intensive screening leads to improved visual acuity; and treatment of strabismus and amblyopia can improve visual acuity and reduce long-term amblyopia.

Routine Vitamin Supplementation to Prevent Cancer and Cardiovascular Disease

The USPSTF concludes that there is insufficient evidence to recommend for or against the use of supplements of vitamins A, C, or E; multivitamins with folic acid; or antioxidant combinations for the prevention of cancer or cardiovascular disease. The available evidence from randomized trials is either inadequate or conflicting, and the influence of confounding variables on observed outcomes in observational studies cannot be determined.