AIM Clinic- Chart Summary of
USPSTF Recommendations Senior Team QI Project- A Garan, L Gedmintas, M
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18 20 |
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Cervical Cancer 3 years after sexually active or |
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Diabetes High risk <45 years BMI>25,
HTN, HDL<35 or TG>250, sedentary, FH of DM, AA, Latino, Asian American,
h/o gestational DM |
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For All Patients HTN BP > 140/90 on 2 readings at
least 1 week apart Obesity BMI >30, lifestyle modification Healthy Diet For pts with CV risk factors, high chol, diet related chronic disease: low sat fat, high
fruit/veg and fiber Tobacco Amount of use, type of use.
Behavioral counseling, pharmacotherapy Alcohol CAGE: cut down, angry/annoyed,
guilty, eye-opener Depression Depressed mood, loss of
interest/pleasure, change in sleep, appetite, weight, psychomotor, loss of
energy or concentration, thoughts of worthlessness, guilt, death, or suicide HIV NYC is a high prevalence area,
screen all patients Domestic Violence SAFE: Stress/safety Afraid/abused Friends/family Emergency plan Seatbelts Bike Helmets Drunk Driving STD counseling |
For High Risk Patients ASA for primary prevention (2009) 75-100mg
daily Male 45-79
(CV prev) F 55-79 (CVAprev) “if
benefit outweighs risk” Pt >80
“I” depends on risk profile PPD recent TB infection, HIV, IVDU,
silicosis, prior TB on CXR, underweight, DM, CRI/HD, gastrectomy,
jejunoileal bypass, renal/cardiac transplant, head
and neck Ca GC/Chlamydia Women <25 years old or high risk sexual behavior Syphillis MSM,
high risk sexual behavior, commercial sex workers, h/o correctional
facilities Hep B screen pregnant women; pts born outside of US Rubella Screen women of childbearing
age: hx of vaccination or serology |
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Lipids High risk >20 years DM, CAD or PAD, early family CV disease, tobacco, HTN, BMI
>30 |
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21 |
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Women >21 years Pap at least every 3 years. Can
extend screening interval if 3 normal paps or
negative HPV testing. If TAH, no need for Pap unless TAH
due to malignancy, in that case pt should continue with GYN surveillance f/u. |
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35 |
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Men >35 years |
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40 |
Breast Cancer Women 50-74 years q 2yrs (B) USPSTF2009 Screening >75
(I) CBE >40
(I) Self Exam
(D) High Risk or pt preference: >40 yrs old(C) For High Risk consider: BRAC 1,2 testing if first degree relatives
with breast or ovarian CA, or men with breast CA in family, also consider
medical or surgical prophylaxis |
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Colorectal Cancer (Earlier if HNPCC, familial polyposis, UC, early family history of colon CA) |
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45 |
High risk Women >45 years Test total Cholesterol and HDL (calculated
LDL) every 3-5 years |
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If HTN, high cholesterol >45 years Fasting
blood glucose > 126, Glucose tolerance test >200 after 2 hours |
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Prostate Cancer
USPSTF:found
insufficient evidence to assess risk/benefit of screening. Pt should
be informed about the test,
risk/benefit, Consider
family hx, race, sx, and
pt preference. If pt
interested, yearly with PSA and DRE begin at age 50 (40-45 for those at
higher risk). No screening recommended after age
75 or if life exp. <10yrs |
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50 |
Women, Men > 50 years Colonoscopy every 10 years or Sigmoidoscopy every 5 years or ANNUAL FOBTx3 |
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60 |
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Osteoporosis High risk > 60 years low
BMI, white or Asian, h/o fracture, FH of osteoporotic fracture, falls,
sedentary, smoking, excessive etoh or caffeine use,
low Ca or vit D intake |
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65 |
If history of normal Paps, STOP screening at 65 |
AAA Men >65 yr past/present smokers Abd US, if >5.5cm, surgery |
Women > 65 years DEXA scan- interval determined
clinically. See fracture calculator on
medicineclinic.org |
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75 |
If hx of nl testing, consider stopping screening at 75, can stop
for all at 85 |
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85 |
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