Re: Stool for occult blood
From: Efrain Ramirez (eramirezt@coqui.net)
Mon Jun 26 00:11:15 2006
You are absolutely right..
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ACOG
Committee on
Gynecologic Practice
This document reflects emerging clinical and scientific advances as of
the date issued and is subject to change. The information should not be
construed as dictating an exclusive course of treatment or procedure to
be followed.
Copyright © November 2003 by the American College of Obstetricians and
Gynecologists. All rights reserved. No part of this publication may be
reproduced, stored in a retrieval system, or transmitted, in any form or
by any means, electronic, mechanical, photocopying, recording, or
otherwise, without prior written permission from the publisher.
Requests for authorization to make photocopies should be directed to:
Copyright Clearance Center
222 Rosewood Drive
Danvers, MA 01923
(978) 750-8400
ISSN 1074-861X
The American College of
Obstetricians and Gynecologists
409 12th Street, SW
PO Box 96920
Washington, DC 20090-6920
12345/76543
Primary and preventive care: periodic assessments. ACOG Committee
Opinion No. 292. American College of Obstetricians and Gynecologists.
Obstet Gynecol 2003;102:1117–24.
Committee
Opinion
[PDF format]
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Number 292, November 2003 (Replaces No. 246, December 2000)
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Primary and Preventive Care:
--------------------------------------------------------------------------------
Periodic Assessments
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ABSTRACT: Periodic assessments provide an excellent opportunity for
obstetricians and gynecologists to provide preventive screening,
evaluation, and counseling. This Committee Opinion provides the
recommendations of the American College of Obstetricians and
Gynecologists' Committee on Gynecologic Practice for routine assessments
in primary and preventive care for women based on age and risk factors.
The following charts are updated versions of those previously published
by the American College of Obstetricians and Gynecologists (ACOG) in
Guidelines for Women's Health Care (2002) and Committee Opinion No. 246.
This version replaces those previous versions. The policies and
recommendations of ACOG committees regarding specific aspects of the
health care of women have been incorporated; they may differ from the
recommendations of other groups. These recommendations are for
nonpregnant women.
Periodic assessments provide an excellent opportunity to counsel
patients about preventive care. These assessments, yearly or as
appropriate, should include screening, evaluation, and counseling based
on age and risk factors. Personal behavioral characteristics are
important aspects of a woman's health. Positive behaviors, such as
exercise, should be reinforced, and negative ones, such as smoking,
should be discouraged. The following guidelines indicate routine
assessments for women based on age groups and risk factors (Table 1) and
list leading causes of death and morbidity for each age group identified
by various sources (see box). It is recognized that variations may be
required to adjust to the needs of a specific individual. For example,
certain risk factors may influence additional assessments and
interventions. Physicians should be alert to high-risk factors
(indicated by an asterisk and further elucidated in Table 1). During
evaluation, the patient should be made aware of high-risk conditions
that require targeted screening or treatment.
The material in these charts is based heavily on evidence of
effectiveness and cost-effectiveness. It should be recognized, however,
that making these determinations is both complex and inexact in the
present environment. Nonetheless, the progress that has been made is
encouraging, and the goal is desirable and of great importance. Although
there will be differences of opinion regarding some specific
recommendations, the major benefit to be derived should not be lost in
debating those issues.
Periodic Assessment
Ages 13-18 Years
Screening
History
Reason for visit
Health status: medical,
surgical, family
Dietary/nutrition assessment
Physical activity
Use of complementary and
alternative medicine
Tobacco, alcohol, other drug
use
Abuse/neglect
Sexual practices
Physical Examination
Height
Weight
Blood pressure
Secondary sexual
characteristics (Tanner
staging)
Pelvic examination (when
indicated by the medical history)
Skin*
Laboratory Testing
Periodic
Cervical cytology (annually begin-
ning at approximately 3 years after initiation
of sexual intercourse)
High-Risk Groups*
Hemoglobin level
assessment
Bacteriuria testing
Sexually transmitted disease testing
Human immunodeficiency
virus (HIV) testing
Genetic testing/counseling
Rubella titer assessment
Tuberculosis skin testing
Lipid profile assessment
Fasting glucose testing
Cholesterol testing
Hepatitis C virus testing
Colorectal cancer screening†
*See Table 1
Evaluation and Counseling
Sexuality
Development
High-risk behaviors
Preventing unwanted/unintended pregnancy
—Postponing sexual involvement
—Contraceptive options, including emergency contraception
Sexually transmitted diseases
—Partner selection
—Barrier protection
Fitness and Nutrition
Dietary/nutrition assessment
(including eating disorders)
Exercise: discussion of program
Folic acid supplementation
(0.4 mg/d)
Calcium intake
Psychosocial Evaluation
Interpersonal/family relationships
Sexual identity
Personal goal development
Behavioral/learning disorders
Abuse/neglect
Satisfactory school experience
Peer relationships
Cardiosvascular Risk Factors
Family history
Hypertension
Dyslipidemia
Obesity
Diabetes mellitus
Health/Risk Behaviors
Hygiene (including dental);
fluoride supplementation*
Injury prevention
—Safety belts and helmets
—Recreational hazards
—Firearms
—Hearing
—Occupational hazards
—School hazards
—Exercise and sports
involvement
Skin exposure to ultraviolet rays
Suicide: depressive symptoms
Tobacco, alcohol, other drug use Immunizations
Periodic
Tetanus-diphtheria booster
(once between ages 11 years and 16 years)
Hepatitis B vaccine (1 series
for those not previously immunized)
High-Risk Groups*
Influenza vaccine
Hepatitis A vaccine
Pneumococcal vaccine
Measles-mumps-rubella vaccine
Varicella vaccine
Leading Causes of Death‡
Accidents
Malignant neoplasms
Homicide
Suicide
Diseases of the heart
Congenital anomalies
Leading Causes of Morbidity‡
Acne
Asthma
Chlamydia
Diabetes mellitus
Headache
Infective, viral, and
parasitic diseases
Mental disorders,
including affective
and neurotic disorders
Nose, throat, ear, and upper
respiratory infections
Sexual assault
Sexually transmitted diseases
Urinary tract infections
Vaginitis
†Only for those with a family history of familial adenomatous polyposis
or 8 years after the start of pancolitis. For a more detailed
discussion of colorectal cancer screening, see Smith RA, von Eschenbach
AC, Wender R, Levin B, Byers T, Rothenberger D, et al. American Cancer
Society guidelines for the early detection of cancer: update of early
detection guidelines for prostate, colorectal, and endometrial cancers.
Also: update 2001-testing for early lung cancer detection (published
erratum appears in CA Cancer J Clin 2001;51:150]. CA Cancer J Clin
2001;51:38-75; quiz 77-80.
‡See box.
Periodic Assessment
Ages 19-39 Years
Screening
History
Reason for visit
Health status: medical,
surgical, family
Dietary/nutrition assessment
Physical activity
Use of complementary and
alternative medicine
Tobacco, alcohol, other drug
use
Abuse/neglect
Sexual practices
Urinary and fecal incontinence
Physical Examination
Height
Weight
Blood pressure
Neck: adenopathy, thyroid
Breasts
Abdomen
Pelvic examination
Skin*
Laboratory Testing
Periodic
Cervical cytology (annually
beginning no later than age 21
years; every 2–3 years after 3 consecutive
negative test results
if age 30 years or older with no
history of cervical
intraepithelial neoplasia
2 or 3, immunosuppression,
human immunodeficiency virus
[HIV] infection, or diethylstilbestrol
exposure in utero)†
High-Risk Groups*
Hemoglobin level
assessment
Bacteriuria testing
Mammography
Fasting glucose testing
Sexually transmitted disease
testing
Human immunodeficiency
virus testing
Genetic testing/counseling
Rubella titer assessment
Tuberculosis skin testing
Lipid profile assessment
Thyroid-stimulating hormone testing
Hepatitis C virus testing
Colorectal cancer screening
Bone density screening Evaluation and Counseling
Sexuality
High-risk behaviors
Contraceptive options
for prevention of unwanted pregnancy,
including emergency contraception
Preconceptional and genetic
counseling for desired pregnancy
Sexually transmitted diseases
—Partner selection
—Barrier protection
Sexual function
Fitness and Nutrition
Dietary/nutrition assessment
Exercise: discussion of program
Folic acid supplementation
(0.4 mg/d)
Calcium intake
Psychosocial Evaluation
Interpersonal/family relationships
Domestic violence
Work satisfaction
Lifestyle/stress
Sleep disorders
Cardiosvascular Risk Factors
Family history
Hypertension
Dyslipidemia
Obesity
Diabetes mellitus
Lifestyle
Health/Risk Behaviors
Hygiene (including dental)
Injury prevention
—Safety belts and helmets
—Occupational hazards
—Recreational hazards
—Firearms
—Hearing
—Exercise and sports involvement
Breast self-examination‡
Chemoprophylaxis for breast
cancer (for high-risk
women ages 35 years or older)§
Skin exposure to ultraviolet rays
Suicide: depressive symptoms
Tobacco, alcohol, other drug use Immunizations
Periodic
Tetanus-diphtheria booster
(every 10 years)
High-Risk Groups*
Measles-mumps-rubella vaccine
Hepatitis A vaccine
Hepatitis B vaccine
Influenza vaccine
Pneumococcal vaccine
Varicella vaccine
Leading Causes of Death
Malignant neoplasms
Accidents
Diseases of the heart
Suicide
Human immunodeficiency virus (HIV) disease
Homicide
Leading Causes of Morbidity
Acne
Appendicitis
Arthritis
Back symptoms
Cancer
Chlamydia
Depression
Diabetes mellitus
Gynecologic disorders
Headache/migraine
Hypertension
Infective, viral, and
parasitic diseases
Joint disorders
Menstrual disorders
Nose, throat, ear, and upper
respiratory infections
Obesity
Sexual assault/domestic violence
Sexually transmitted diseases
Skin rash/dermatitis
Substance abuse
Urinary tract infections
*See Table 1
†For a more detailed discussion of cervical cytology screening,
including the use of human papillomavirus DNA testing and screening
after hysterectomy, see Cervical cytology screening. ACOG Practice
Bulletin No. 45. American College of Obstetricians and Gynecologists.
Obstet Gynecol 2003;102:417-27.
‡Despite a lack of definite data for or against breast self-examination,
breast self-examination has the potential to detect palpable breast
cancer and can be recommended.
§For a more detailed discussion of risk assessment and chemoprevention
therapy, see Selective estrogen receptor modulators. ACOG Practice
Bulletin No. 39. American College of Obstetricians and Gynecologists.
Obstet Gynecol 2002;100:835-43.
See box.
Periodic Assessment
Ages 40-64 Years
Screening
History
Reason for visit
Health status: medical,
surgical, family
Dietary/nutrition assessment
Physical activity
Use of complementary and
alternative medicine
Tobacco, alcohol,
other drug use
Abuse/neglect
Sexual practices
Urinary and
fecal incontinence
Physical Examination
Height
Weight
Blood pressure
Oral cavity
Neck: adenopathy, thyroid
Breasts, axillae
Abdomen
Pelvic examination
Skin*
Laboratory Testing
Periodic
Cervical cytology
(every 2–3 years after 3 consecutive
negative test results
if no
history of cervical
intraepithelial neoplasia
2 or 3, immunosuppression,
human immunodeficiency virus
[HIV] infection, or diethylstilbestrol
exposure in utero)†
Mammography (every
1-2 years beginning at age 40
years, yearly beginning
at age 50 years)
Lipid profile assessment (every 5 years
beginning at age 45 years)
Yearly fecal occult blood
testing or flexible
sigmoidoscopy every
5 years or yearly fecal occult blood
testing plus flexible sigmoidoscopy
every 5 years or
double contrast barium
enema every 5
years, or
colonoscopy every 10 years
(beginning at age 50 years)
Fasting glucose testing
(every 3 years after age 45 years)
Thyroid-stimulating hormone
screening (every 5 years beginning
at age 50 years)
High-Risk Groups*
Hemoglobin level
assessment
Bacteriuria testing
Fasting glucose testing
Sexually transmitted
disease testing
Human
immunodeficiency
virus testing
Tuberculosis skin testing
Lipid profile assessment
Thyroid-stimulating hormone testing
Hepatitis C virus testing
Colorectal cancer screening
*See Table 1.
Evaluation and Counseling
Sexuality‡
High-risk behaviors
Contraceptive options
for prevention of
unwanted pregnancy,
including emergency contraception
Sexually transmitted
diseases
—Partner selection
—Barrier protection
Sexual functioning
Fitness and Nutrition
Dietary/nutrition
assessment
Exercise: discussion of
program
Folic acid
supplementation
(0.4 mg/d before age
50 years)
Calcium intake
Psychosocial Evaluation
Family relationships
Domestic violence
Work satisfaction
Retirement planning
Lifestyle/stress
Sleep disorders
Cardiosvascular Risk Factors
Family history
Hypertension
Dyslipidemia
Obesity
Diabetes mellitus
Lifestyle
Health/Risk Behaviors
Hygiene (including dental)
Hormone therapy
Injury prevention
—Safety belts and
helmets
—Occupational hazards
—Recreational hazards
—Exercise and sports
involvement
—Firearms
—Hearing
Breast self-examination§
Chemoprophylaxis
for breast cancer
(for high-risk women)
Skin exposure to
ultraviolet rays
Suicide: depressive
symptoms
Tobacco, alcohol,
other drug use Immunizations
Periodic
Influenza vaccine
(annually beginning
at age 50 years)
Tetanus-diphtheria booster
(every 10 years)
High-Risk Groups*
Measles-mumps-rubella vaccine
Hepatitis A vaccine
Hepatitis B vaccine
Influenza vaccine
Pneumococcal vaccine
Varicella vaccine
Leading Causes of Death¶
Malignant neoplasms
Diseases of the heart
Cerebrovascular diseases
Chronic lower respiratory disease
Diabetes mellitus
Accidents
Chronic liver disease and cirrhosis
Suicide
Human immunodeficiency virus (HIV) disease
Leading Causes of Morbidity¶
Arthritis/osteoarthritis
Asthma
Back symptoms
Cancer
Cardiovascular disease
Depression
Diabetes mellitus
Headache/migraine
Hypertension
Menopause
Mental disorders, including
affective and neurotic
disorders
Mononeuritis of upper limb
and monoeuritis multiplex
Nose, throat, ear, and upper
respiratory infections
Obesity
Pneumonia
Sexually transmitted diseases
Skin conditions/dermatitis
Ulcers
Urinary tract infections
Vision impairment
†For a more detailed discussion of cervical cytology screening,
including the use of human papillomavirus DNA testing and screening
after hysterectomy, see Cervical Cytology screening. ACOG Practice
Bulletin No. 45. American College of Obstetricians and Gynecologists.
Obstet Gynecol 2003;102:417-27.
‡Preconceptional and genetic counseling is appropriate for certain women
in this age group.
§Despite a lack of definitive data for or against breast
self-examination, breast self-examination has the potential to detect
palpable breast cancer and can be recommended.
For a more detailed discussion of risk assessment and chemoprevention
therapy, see Selective estrogen receptor modulators. ACOG Practice
Bulletin No. 39. American College of Obstetricians and Gynecologists.
Obstet Gynecol 2002;100:835–43.
¶See box.
Periodic Assessment
Age 65 Years and Older
Screening
History
Reason for visit
Health status: medical,
surgical, family
Dietary/nutrition assessment
Physical activity
Use of complementary and
alternative medicine
Tobacco, alcohol, other
drug use, and concurrent
medication use
Abuse/neglect
Sexual practices
Urinary and fecal
incontinence
Physical Examination
Height
Weight
Blood pressure
Oral cavity
Neck: adenopathy, thyroid
Breasts, axillae
Abdomen
Pelvic examination
Skin*
Laboratory Testing
Periodic
Cervical cytology
(every 2–3 years after 3 consecutive
negative test results
if no
history of cervical
intraepithelial neoplasia
2 or 3, immunosuppression,
human immunodeficiency virus
[HIV] infection, or diethylstilbestrol
exposure in utero)†
Urinalysis
Mammography
Lipid profile assessment
(every 5 years)
Yearly fecal occult blood
testing or flexible
sigmoidoscopy every
5 years or yearly fecal occult blood
testing plus flexible sigmoidoscopy
every 5 years or
double contrast barium
enema every 5
years, or
colonoscopy every 10 years
Fasting glucose testing
(every 3 years)
Bone density screening‡
Thyroid-stimulating hormone
screening (every 5
years)
High-Risk Groups*
Hemoglobin level
assessment
Sexually transmitted
disease testing
Human immunodeficiency
virus testing
Tuberculosis skin testing
Thyroid-stimulating hormone screening
Hepatitis C virus testing
Colorectal cancer screening Evaluation and Counseling
Sexuality
Sexual functioning
Sexual behaviors
Sexually transmitted
diseases
—Partner selection
—Barrier protection
Fitness and Nutrition
Dietary/nutrition assessment
Exercise: discussion of program
Calcium intake
Psychosocial Evaluation
Neglect/abuse
Lifestyle/stress
Depression/sleep
disorders
Family relationships
Work/retirement
satisfaction
Cardiosvascular Risk Factors
Hypertension
Dyslipidemia
Obesity
Diabetes mellitus
Sedentary Lifestyle
Health/Risk Behaviors
Hygiene (including
dental)
Hormone therapy
Injury prevention
—Safety belts and helmets
—Prevention of falls
—Occupational hazards
—Recreational hazards
—Exercise and sports
involvement
—Firearms
Visual acuity/glaucoma
Hearing
Breast self-examination§
Chemoprophylaxis
for breast cancer
(for high-risk women)
Skin exposure to
ultraviolet rays
Suicide: depressive symptoms
Tobacco, alcohol, other
drug use Immunizations
Periodic
Tetanus-diphtheria booster
(every 10 years)
Influenza vaccine (annually)
Pneumococcal vaccine (once)
High-Risk Groups*
Hepatitis A vaccine
Hepatitis B vaccine
Varicella vaccine
Leading Causes of Death¶
Diseases of the heart
Malignant neoplasms
Cerebrovascular diseases
Chronic lower respiratory diseases
Alzheimer's disease
Influenza and pneumonia
Diabetes mellitus
Leading Causes of Morbidity¶
Arthritis/Osteoarthritis
Asthma
Back symptoms
Cancer
Cardiovascular disease
Chronic obstructive pulmonary diseases
Diabetes mellitus
Hearing and vision impairment
Hypertension
Mental disorders, including
affective and neurotic
disorders
Nose, throat, and upper
respiratory infections
Obesity
Osteoporosis
Pneumonia
Septicemia
Skin lesions/dermatoses/dermatitis
Ulcers
Urinary tract infections
Urinary tract (other conditions,
including urinary incontinence)
Vertigo
*See Table 1
†For a more detailed discussion of cervical cytology screening,
including the use of human papillomavirus DNA testing and screening
after hysterectomy, see Cervical Cytology screening. ACOG Practice
Bulletin No. 45. American College of Obstetricians and Gynecologists.
Obstet Gynecol 2003;102:417-27.
‡In the absence of new risk factors, subsequent bone density screening
should not be performed more frequently than every 2 years.
§Despite a lack of definitive data for or against breast
self-examination, breast self-examination has the potential to detect
palpable breast cancer and can be recommended.
For a more detailed discussion of risk assessment and chemoprevention
therapy, see Selective estrogen receptor modulators. ACOG Practice
Bulletin No. 39. American College of Obstetricians and Gynecologists.
Obstet Gynecol 2002;100:835–43.
¶See box.
Table 1. High-Risk Factors
Intervention High-Risk Factor
Bacteriuria testing Diabetes mellitus
Bone density screening* Postmenopausal women younger than 65 years:
personal history of fracture as an adult; history of fracture in a
first-degree relative; Caucasian; dementia; poor health or frailty;
current cigarette smoking; low body weight (<127 lb); estrogen
deficiency caused by early (age <45 years) menopause, bilateral
ovariectomy, or prolonged (>1 year) premenopausal amenorrhea; low
lifelong calcium intake; alcoholism; impaired eyesight despite adequate
correction; recurrent falls; inadequate physical activity. All women:
certain diseases or medical conditions and those who take certain drugs
associated with an increased risk of osteoporosis
Colorectal cancer screening† Colorectal cancer or adenomatous polyps in
first-degree relative younger than 60 years or in 2 or more first-degree
relatives of any ages; family history of familial adenomatous polyposis
or hereditary nonpolyposis colon cancer; history of colorectal cancer,
adenomatous polyps, inflammatory bowel disease, chronic ulcerative
colitis, or Crohn's disease
Fasting glucose testing Overweight (body mass index >% kg/m2); family
history of diabetes mellitus; habitual physical inactivity; high-risk
race/ethnicity (eg, African American, Hispanic, Native American, Asian,
Pacific Islander); have given birth to a newborn weighing more than 9 lb
or history of gestational diabetes mellitus; hypertension; high-density
lipoprotein cholesterol level <5 mg/dL; triglyceride level >%0
mg/dL; history of impaired glucose tolerance or impaired fasting
glucose; polycystic ovary syndrome; history of vascular disease
Fluoride supplementation Live in area with inadequate water fluoridation
(<0.7 ppm)
Genetic testing/counseling Considering pregnancy and: will be 35 years
or older at time of delivery; patient, partner, or family member with
history of genetic disorder or birth defect; exposure to teratogens; or
African, Acadian, European Caucasian, Eastern European (Ashkenazi)
Jewish, Mediterranean, or Southeast Asian ancestry
Hemoglobin level assessment Caribbean, Latin American, Asian,
Mediterranean, or African ancestry; history of excessive menstrual flow
HAV vaccination Chronic liver disease; clotting factor disorders;
illegal drug users; individuals who work with HAV-infected nonhuman
primates or with HAV in a research laboratory setting; individuals
traveling to or working in countries that have high or intermediate
endemicity of hepatitis A
HBV vaccination Hemodialysis patients; patients who receive clotting
factor concentrates; health care workers and public safety workers who
have exposure to blood in the workplace; individuals in training in
schools of medicine, dentistry, nursing, laboratory technology, and
other allied health professions; injecting drug users; individuals with
more than 1 sexual partner in the previous 6 months; individuals with a
recently acquired STD; all clients in STD clinics; household contacts
and sexual partners of individuals with chronic HBV infection; clients
and staff of institutions for the developmentally disabled;
international travelers who will be in countries with high or
intermediate prevalence of chronic HBV infection for more than 6 months;
inmates of correctional facilities
HCV testing History of injecting illegal drugs; recipients of clotting
factor concentrates before 1987; chronic (long-term) hemodialysis;
persistently abnormal alanine aminotransferase levels; recipient of
blood from a donor who later tested positive for HCV infection;
recipient of blood or blood-component transfusion or organ transplant
before July 1992; occupational percutaneous or mucosal exposure to
HCV-positive blood
HIV testing Seeking treatment for STDs; drug use by injection; history
of prostitution; past or present sexual partner who is HIV positive or
bisexual or injects drugs; long-term residence or birth in an area with
high prevalence of HIV infection; history of transfusion from 1978 to
1985; invasive cervical cancer. Offer to women seeking preconceptional
evaluation.
Influenza vaccination Anyone who wishes to reduce the chance of becoming
ill with influenza; chronic cardiovascular or pulmonary disorders
including asthma; chronic metabolic diseases, including diabetes
mellitus, renal dysfunction, hemoglobinopathies, and immunosuppression
(including immunosuppression caused by medications or by HIV); residents
of nursing homes and other long-term care facilities; individuals likely
to transmit influenza to high-risk individuals (eg, household members
and caregivers of elderly, those with medical indications, and adults
with high-risk conditions); health care workers; day care workers
Lipid profile assessment Family history suggestive of familial
hyperlipidemia; family history of premature (age <50 years for men, age
<60 years for women) cardiovascular disease; diabetes mellitus; multiple
coronary heart disease risk factors (eg, tobacco use, hypertension)
Mammography Women who have had breast cancer or who have a first-degree
relative (ie, mother, sister, or daughter) or multiple other relatives
who have a history of premenopausal breast or breast and ovarian cancer
MMR vaccination Adults born in 1957 or later should be offered
vaccination (1 dose of MMR) if there is no proof of immunity or
documentation of a dose given after first birthday; individuals
vaccinated in 1963–1967 should be offered revaccination (2 doses);
health care workers, students entering college, international travelers,
and rubella-negative postpartum patients should be offered a second
dose.
Pneumococcal vaccination Chronic illness, such as cardiovascular
disease, pulmonary disease, diabetes mellitus, alcoholism, chronic liver
disease, cerebrospinal fluid leaks, functional asplenia (eg, sickle cell
disease) or splenectomy; exposure to an environment where pneumococcal
outbreaks have occurred; immunocompromised patients (eg, HIV infection,
hematologic or solid malignancies, chemotherapy, steroid therapy).
Revaccination after 5 years may be appropriate for certain high-risk
groups.
Rubella titer assessment Childbearing age and no evidence of immunity
STD testing History of multiple sexual partners or a sexual partner with
multiple contacts, sexual contact with individuals with culture-proven
STD, history of repeated episodes of STDs, attendance at clinics for
STDs; routine screening for chlamydial infection for all sexually active
women aged 25 years or younger and other asymptomatic women at high risk
for infection; routine screening for gonorrheal infection for all
sexually active adolescents and other asymptomatic women at high risk
for infection
Skin examination Increased recreational or occupational exposure to
sunlight; family or personal history of skin cancer; clinical evidence
of precursor lesions
Thyroid-stimulating hormone testing Strong family history of thyroid
disease; autoimmune disease (evidence of subclinical hypothyroidism may
be related to unfavorable lipid profiles)
Tuberculosis skin testing Human immunodeficiency virus infection; close
contact with individuals known or suspected to have tuberculosis;
medical risk factors known to increase risk of disease if infected; born
in country with high tuberculosis prevalence; medically underserved; low
income; alcoholism; intravenous drug use; resident of long-term care
facility (eg, correctional institutions, mental institutions, nursing
homes and facilities); health professional working in high-risk health
care facilities
Varicella vaccination All susceptible adults and adolescents, including
health care workers; household contacts of immunocompromised
individuals; teachers; day-care workers; residents and staff of
institutional settings, colleges, prisons, or military installations;
adolescents and adults living in households with children; international
travelers; nonpregnant women of childbearing age
Abbreviations: HAV, hepatitis A virus; HBV, hepatitis B virus; HCV,
hepatitis C virus; HIV, human immunodeficiency virus; MMR,
measles–mumps–rubella; STD, sexually transmitted disease.
*For a more detailed discussion of bone density screening, see Bone
density screening for osteoporosis. ACOG Committee Opinion No. 270.
American College of Obstetricians and Gynecologists. Obstet Gynecol
2002;99:523–5.
†For a more detailed discussion of colorectal cancer screening, see
Smith RA, von Eschenbach AC, Wender R, Levin B, Byers T, Rothenberger D,
et al. American Cancer Society guidelines for the early detection of
cancer: update of early detection guidelines for prostate, colorectal,
and endometrial cancers. Also: update 2001—testing for early lung
cancer detection [published erratum appears in CA Cancer J Clin
2001;51:150]. CA Cancer J Clin 2001;51:38–75; quiz 77–80.
Sources of Leading Causes of Mortality and Morbidity
Leading causes of mortality are provided by the Mortality Statistics
Branch at the National Center for Health Statistics. Data are from
2000, the most recent year for which final data are available. The
causes are ranked.
Leading causes of morbidity are unranked estimates based on information
from the following sources:
National Health Interview Survey, 1998
National Ambulatory Medical Care Survey, 2001
National Health and Nutrition Examination Survey III, 1998
National Hospital Discharge Survey, 2001
National Nursing Home Survey, 1997
U.S. Department of Justice National Crime Victimization Survey
U.S. Centers for Disease Control and Prevention Sexually Transmitted
Disease Surveillance, 2001
U.S. Centers for Disease Control and Prevention HIV/AIDS Surveillance
Report, 2001
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At Sun, 25 Jun 2006, Meenan, Anna wrote:
>
>I would say no, you're not liable, but then I'm not a plaintiff lawyer.
>
>Anna Meenan, MD
>
>>So - a 44y/o or so she phones you that she has a Stage IV colon ca --
>>saw you months ago - did not order stool for occult blood - are you
>>liable?? no family history...
>>
>>Ef
>>
>> At Sun, 25 Jun 2006, Andrew Folley wrote:
>>>
>>>I routinely do rectal exams for stool and occult blood starting at age 40.
>>>Send ohome hemoccult kits for those 50 and over. agf
>>>
>>>>From: eramirezt@coqui.net (Efrain Ramirez)
>>>>Reply-To: ob-gyn-l@obgyn.net
>>>>To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net>
>>>>Subject: Stool for occult blood Date: Sun, 25 Jun 2006 15:04:07 -0500
>>>>
>>>>Who in the list orders yearly stool for occult blood between 40 and 49
>>>>years old(young) - no pertinent family history.
>>>>
>>>>Ef
>>>>
>>>>--
>>>>ì The greatest obstacle to knowledge is not ignorance,
>>>>it is the illusion of knowledge.î Daniel J. Boorstin - Historian
>>
>>--
>>ì The greatest obstacle to knowledge is not ignorance,
>>it is the illusion of knowledge.î Daniel J. Boorstin - Historian
--
“ The greatest obstacle to knowledge is not ignorance,
it is the illusion of knowledge.” Daniel J. Boorstin - Historian
