Items in AFP with MESH term: Mass Screening
How Do Clinical Practice Guidelines Go Awry? - AFP Journal Club
ABSTRACT: Adolescent idiopathic scoliosis is the most common form of scoliosis, affecting approximately 2% to 4% of adolescents. The incidence of scoliosis is about the same in males and females; however, females have up to a 10-fold greater risk of curve progression. Although most youths with scoliosis will not develop clinical symptoms, scoliosis can progress to rib deformity and respiratory compromise, and can cause significant cosmetic problems and emotional distress for some patients. For decades, scoliosis screenings were a routine part of school physical examinations in adolescents. The U.S. Preventive Services Task Force and American Academy of Family Physicians recommend against routine scoliosis screening in asymptomatic adolescents, concluding that harm from screening outweighs the benefit because screenings expose many low-risk adolescents to unnecessary radiographs and referrals. In contrast, the Scoliosis Research Society, American Academy of Orthopaedic Surgeons, American Academy of Pediatrics, and Pediatric Orthopaedic Society of North America suggest that the potential benefit of detecting scoliosis early justifies screening programs, but greater care should be used in deciding which patients with positive screening results need further evaluation. The goal for primary care physicians is to identify patients who are at risk of developing problems from scoliosis, without overtesting or overreferring patients who are unlikely to have further problems. Physical examination with the Adam’s forward bend test and a scoliometer measurement can guide judicious use of radiologic testing for Cobb angle measurement and orthopedic referrals. Treatment options include observation, braces, and surgery.
ABSTRACT: Iron deficiency is the most common nutritional disorder worldwide and accounts for approximately one-half of anemia cases. The diagnosis of iron deficiency anemia is confirmed by the findings of low iron stores and a hemoglobin level two standard deviations below normal. Women should be screened during pregnancy, and children screened at one year of age. Supplemental iron may be given initially, followed by further workup if the patient is not responsive to therapy. Men and postmenopausal women should not be screened, but should be evaluated with gastrointestinal endoscopy if diagnosed with iron deficiency anemia. The underlying cause should be treated, and oral iron therapy can be initiated to replenish iron stores. Parenteral therapy may be used in patients who cannot tolerate or absorb oral preparations.
Screening for Hearing Loss in Older Adults - Putting Prevention into Practice
General Health Checks for Reducing Morbidity and Mortality - Cochrane for Clinicians
ABSTRACT: Peripheral arterial disease (PAD) is atherosclerosis leading to narrowing of the major arteries distal to the aortic arch. The most common presenting symptom is claudication; however, only 10% of patients have classic claudication. Approximately 8 to 12 million Americans have PAD, including 15% to 20% of adults older than 70 years. The ankle-brachial index (ABI) can be used to screen for and diagnose PAD in the primary care setting. An ABI of less than 0.9 is associated with a two- to fourfold increase in relative risk for cardiovascular events and all-cause mortality. To improve cardiovascular risk stratification and risk factor modification, the American Diabetes Association recommends ABI screening for patients older than 50 years who have diabetes mellitus, and the American Heart Association recommends screening all patients 65 years and older and those 50 years and older who have a history of diabetes or smoking. Because there is no evidence that screening leads to fewer cardiovascular events or lower all-cause mortality, the U.S. Preventive Services Task Force recommends against screening for PAD. Management of claudication includes exercise, smoking cessation, statin therapy, and antiplatelet therapy with aspirin or clopidogrel, and possibly cilostazol in patients with no history of heart failure. Surgical revascularization may be considered in patients with lifestyle-limiting claudication symptoms that do not respond to medical therapy.
Common Questions About Barrett Esophagus - Article
ABSTRACT: Barrett esophagus is a precancerous metaplasia of the esophagus that is more common in patients with chronic reflux symptoms, although it also occurs in patients without symptomatic reflux. Other risk factors include smoking, male sex, obesity, white race, hiatal hernia, and increasing age (particularly older than 50 years). Although Barrett esophagus is a risk factor for esophageal adenocarcinoma, its management and the need for screening or surveillance endoscopy are debatable. The annual incidence of progression to esophageal cancer is 0.12% to 0.33%; progression is more common in patients with high-grade dysplasia and long-segment Barrett esophagus. Screening endoscopy should be considered for patients with multiple risk factors, and those who have lesions with high-grade dysplasia should undergo endoscopic mucosal resection or other endoscopic procedures to remove the lesions. Although the cost-effectiveness is questionable, patients with nondysplastic Barrett esophagus can be followed with endoscopic surveillance. Lowgrade dysplasia should be monitored or eradicated via endoscopy. Although there is no evidence that medical or surgical therapies to reduce acid reflux prevent neoplastic progression, proton pump inhibitors can be used to help control reflux symptoms.