Page 301 - TNFlipTest

Toronto Notes 2019 Periodic Health Examination
• weak:desirableeffectsprobablyoutweightheundesirableeffects(weakrecommendationforan intervention) or undesirable effects probably outweigh the desirable effects (weak recommendation against an intervention)
■ implies that most people would want the recommended course of action but that many would not ■ different choices will be appropriate for different individuals, patients require support in reaching a
management decision consistent with his/her values and preferences
Quality of Evidence
• high:highlevelofconfidencethattrueeffectliesclosetotheestimateoftheeffect
• moderate:trueeffectlikelytobeclosetotheestimateoftheeffect,butthereisapossibilitythatitis
substantially different
• loworverylow:trueeffectmaybesubstantiallydifferentfromtheestimateoftheeffect
Family Medicine FM3
Table 1. Periodic Health Exam
Discussion
General Population
Dental hygiene (community fluoridation, brushing, flossing) (A)
Noise control and hearing protection (A)
Screen for poverty
Smokers: counsel on smoking cessation, provide: Nicotine replacement therapy (A)
Referral to smoking cessation program (B)
Dietary advice on leafy green vegetables and fruits (B) Seat belt use (B)
Injury prevention (bicycle helmets, smoke detectors) (B) Moderate physical activity (B)
Avoid sun exposure and wear protective clothing (B) Problem drinking screening and counselling (B) Counselling to protect against STIs (B)
Nutritional counselling and dietary advice on fat and cholesterol (B)
Dietary advice on calcium and vitamin D requirements (B)
Blood pressure measurement, using techniques described in CHEP guidelines (strong recommendation; moderate quality evidence)
BMI measurement in obese adults (B)
See recommendations below for age and gender specific screening for diabetes, dyslipidemia, hypertension and cancer screening (colon, prostate, cervical, lung, and breast)
Folic acid supplementation to women of child-bearing
age (A)
Pharmacologic treatment of HTN (Refer to CHEP Guidelines) (A)
Varicella vaccine for children age 1-12 and susceptible adolescents/adults (A)
Rubella vaccine for all non-pregnant women of child-bearing age unless there is proof of immunity via immunization records or serology (B)
Tetanus vaccine: routine booster q10yr if had 1° series (A) Pertussis vaccine: adults <65 should receive one booster given as Tdap– Adacel® or Boostrix® (A)
Herpes zoster vaccine for adults ≥60
Special Population
Pediatrics: Home visits for high risk families (A), Inquiry into developmental milestones (B)
Adolescents: Counsel on sexual activity and contraceptive methods (B), Counsel to prevent smoking initiation and substance use (B)
Perimenopausal Women (>50): Assess for risk factors for: osteoporosis and fracture (A), Counsel on osteoporosis, Counsel on risks/benefits of hormone replacement therapy (B)
Adults >65: Follow-up on caregiver concern of cognitive impairment (A), Multidisciplinary post-fall assessment (A)
Pediatrics: Repeated examinations of hips, eyes and hearing (especially in first year of life) (A), Serial height, weight and head circumference (B), Visual acuity testing after age 2 (B)
Adults >65: Visual acuity (Snellen sight chart) (B), Hearing impairment (inquiry, whispered voice test, audioscope) (B)
First-Degree Relative with Melanoma: Full body skin exam (B)
Pediatrics: Routine hemoglobin for high risk infants (B), Blood lead screening of high risk infants (B)
TB High Risk Groups: Mantoux skin testing (A)
STI High Risk Groups: Voluntary HIV antibody screening (A), Gonorrhea screening (A), Chlamydia screening in women (B), Syphillis screening (A)
Syphilis Risk Group: VDRL test (A)
Pediatrics: Routine immunizations (A), Hepatitis B, HPV
and Meningococcal immunizations are offered in schools in most Canadian provinces
Influenza High Risk Groups: Outreach strategies for vaccination (A), Annual immunization (B), now recommended for all
TB High Risk Groups INH prophylaxis for household contacts or skin test converters (B), INH prophylaxis for high risk sub-groups (B)
Immunocompromised/Age≥65/COPD/Asthma/CHF/ Asplenia/Liver Disease/Renal Failure/DM: Pneumococcal vaccine (Pneumovax®) (A)
Physical
Tests
Therapy
Choosing Wisely Canada
http://www.choosingwiselycanada.org/
A campaign to help clinicians and patients engage in conversations about unnecessary tests and treatments and make smart and effective choices to ensure high quality care
Folic Acid Supplementation in Pregnancy (Joint SOGC-Motherisk Clinical Guideline May 2015)
• To prevent neural tube defects in all women
capable of becoming pregnant
• Low risk women (no personal health risks,
planned pregnancy): diet of folate-rich foods and a daily oral multivitamin supplement containing 0.4-1.0 mg folic acid for at least 2-3 mo before conception, throughout pregnancy, and 4 to 6 weeks postpartum or as long as breast-feeding continues
• High risk women (health risks including epilepsy, insulin-dependent diabetes,
BMI >35, family history of NTD, high risk ethnic group): diet of folate-rich foods and daily supplementation with multivitamins with 5 mg folic acid at least 3 mo prior to conception until 12 wk post conception
• From wk 12 post-conception until postpartum period (4-6 wks or as long as breastfeeding continues): 0.4-1.0 mg of folic acid supplementation is sufficient
• Women with additional lifestyle issues (poor compliance with medications, no consistent birth control, taking possible teratogenic substances): higher folic acid dose of 5 mg and counselling about prevention of birth defects
Classification of recommendation in brackets: A - High quality of evidence; B – Moderate quality of evidence. See www.canadiantaskforce.ca – for up-to-date guidelines Reference: Canadian Task Force on Preventive Health Care, 2014
Breast Cancer Screening Guidelines
2011 Canadian Task Force on Preventive Health Care
• average-riskwomen:womenage40-74withnopersonalhistoryofbreastcancer,historyofbreast cancer in 1st degree relatives, known mutations of the BRCA1/BRCA2 genes or previous exposures of the chest wall to radiation