| Surgeries performed with the intent to limit the venous outflow of the penis are not recommended. | Perform Therapeutic Procedure | Test | 0.61 |
| Caregivers should be trained to assess neonates for pain using multidimensional tools. | Prepare | Prepare | 0.48 |
| Caregivers should be trained to assess neonates for pain using multidimensional tools. | Prepare | Educate/Counsel | 0.21 |
| Surveillance colonoscopy with multiple biopsy specimens should be performed every 1 to 2 years beginning after 8 to 10 years of disease. | Monitor | Monitor | 0.8 |
| It is recommended that patients with a severe head injury receive an early tracheostomy. | Perform Therapeutic Procedure | Perform Therapeutic Procedure | 0.23 |
| It is recommended that patients with a severe head injury receive an early tracheostomy. | Perform Therapeutic Procedure | Prescribe | 0.75 |
| It is recommended that patients in whom discography is positive but in whom MR imaging evidence of disc degeneration is absent not be considered candidates for operative intervention. | Perform Therapeutic Procedure | Perform Therapeutic Procedure | 0.98 |
| The USPSTF recommends against routine screening for elevated blood lead levels in asymptomatic children aged 1 to 5 years who are at average risk . | Test | Test | 1 |
| Physicians should fully explain diagnosis, prognosis, and all treatment options to each patient. | Educate/Counsel | Educate/Counsel | 0.84 |
| Brief cognitive assessment instruments that focus on limited aspects of cognitive function (i.e., Clock Drawing Test, Time and Change Test) may be considered when screening patients for dementia. | Test | Test | 1 |
| Nonsteroidal anti-inflammatory drugs (NSAIDs) or acetaminophen may be used as adjuncts to opioids in selected patients. | Prescribe | Prescribe | 0.97 |
| Use of unattended APAP to either initially determine pressures for fixed CPAP or for self-adjusting APAP treatment in CPAP-naïve patients is not currently established. | Perform Therapeutic Procedure | Perform Therapeutic Procedure | 1 |
| Orotracheal intubation guided by direct laryngoscopy is the emergency tracheal intubation procedure of choice for trauma patients. | Perform Therapeutic Procedure | Perform Therapeutic Procedure | 1 |
| A focused exam of the hair and scalp should be performed. | Examine | Monitor | 0.31 |
| A focused exam of the hair and scalp should be performed. | Examine | Examine | 0.23 |
| Programme providers should also ensure that support is available to enable the participation of parents who might otherwise find it difficult to access these programmes. | Prepare | Prepare | 1 |
| For patients with systolic dysfunction (ejection fraction [EF] <40%) who have no contraindications:Aldosterone antagonist (low dose) for patients with rest dyspnea or with a history of rest dyspnea or for symptomatic patients who have suffered a recent myocardial infarction . | Prescribe | Prescribe | 0.99 |
| Specialized nutrition support (SNS) should be used in patients who cannot meet their nutrient requirements by oral intake. | Perform Therapeutic Procedure | Perform Therapeutic Procedure | 0.99 |
| Healthcare professionals should have an increased awareness of the possibility of the presence of otitis media with effusion in asymptomatic children. | Prepare | Prepare | 0.92 |
| Currently, data available from class II studies do not provide sufficient evidence that routine MRI should be performed on all very low birth weight (VLBW) infants for whom results of screening cranial US are abnormal. | Test | Test | 1 |
| A standing anteroposterior (AP) and a lateral view should be taken initially. A tangential view of the patella-femoral joint ("sunrise" view) and a standing posteroanterior (PA) view taken in 40 degrees of flexion can be useful. | Test | Test | 1 |
| All patients with acute stroke should undergo brain scanning (computed tomography [CT] or magnetic resonance imaging [MRI]) as soon as possible preferably within 24 hours (GPP). A local protocol for more urgent scans should be made available. | Prepare | Test | 1 |
| All patients with acute stroke should undergo brain scanning (computed tomography [CT] or magnetic resonance imaging [MRI]) as soon as possible preferably within 24 hours (GPP). A local protocol for more urgent scans should be made available. | Test | Test | 1 |
| Surgical Management:The anterolateral approach is recommended for hemiarthroplasty. | Perform Therapeutic Procedure | Perform Therapeutic Procedure | 0.87 |
| Routine screening for IUGR in low-risk patients should comprise classical clinical monitoring techniques. Ultrasound evaluation of the fetus is appropriate in patients determined to be at high risk. | Test | Monitor | 0.97 |
| Routine screening for IUGR in low-risk patients should comprise classical clinical monitoring techniques. Ultrasound evaluation of the fetus is appropriate in patients determined to be at high risk. | Monitor | Monitor | 0.97 |
| The presence of maternal thyroid disease is important information for the pediatrician to have at the time of delivery. | Test | Test | 0.25 |
| The presence of maternal thyroid disease is important information for the pediatrician to have at the time of delivery. | Test | Educate/Counsel | 0.72 |
| Pain response to therapy should not be used as the sole diagnostic indicator of the underlying etiology of an acute headache. | Conclude | Conclude | 0.91 |
| Counsel obese and overweight women about the risks of weight cycling--repeated episodes of weight loss and gain--and the benefits of adopting long-term healthy eating habits. | Educate/Counsel | Educate/Counsel | 1 |
| Critical Illness Patients with critical illnesses are at nutrition risk and should undergo nutrition screening to identify those who require formal nutrition assessment with development of a nutrition care plan. | Inquire | Inquire | 0.93 |
| Educate caregivers to assist in their ability to care for the wanderer. | Educate/Counsel | Prepare | 0.26 |
| Educate caregivers to assist in their ability to care for the wanderer. | Educate/Counsel | Educate/Counsel | 0.53 |
| If thrombocytopenia is accompanied by other cytopenias or splenomegaly and is mild (>50,000 cells/mm3), hypersplenism caused by infectious causes or coincident liver disease should be suspected. | Conclude | Conclude | 0.99 |
| Vision screening should be performed at the earliest possible age and at regular intervals during childhood as recommended by the American Academy of Pediatrics (AAP). The goal remains to eliminate preventable blindness and treatable visual disability. | Monitor | Monitor | 1 |
| The U.S. Preventive Services Task Force concludes that the evidence is insufficient to recommend for or against routine clinical breast examination (CBE) alone to screen for breast cancer. | Examine | Test | 1 |
| Patients should be instructed in the correct use of glucose meters, including quality control. Comparison between SMBG and concurrent laboratory glucose analysis should be performed at regular intervals to evaluate the accuracy of patient results. | Educate/Counsel | Monitor | 0.81 |
| Patients should be instructed in the correct use of glucose meters, including quality control. Comparison between SMBG and concurrent laboratory glucose analysis should be performed at regular intervals to evaluate the accuracy of patient results. | Monitor | Monitor | 0.81 |
| Parental choice regarding management of the delivery and subsequent care of the infant should be respected within the limits of medical feasibility and appropriateness | Conclude | Conclude | 0.6 |
| The USPSTF concludes that the evidence is insufficient to recommend for or against the routine use of human papillomavirus (HPV) testing as a primary screening test for cervical cancer. | Test | Test | 1 |
| Pediatricians can work locally, nationally, and internationally to help change cultural norms conducive to eating disorders and proactively to change media messages. | Advocate | Advocate | 1 |
| At present there is insufficient evidence to recommend gemcitabine combined with a taxane as first-line therapy for non-small cell lung cancer. | Prescribe | Prescribe | 1 |
| Nutrition Screening A procedure for periodic nutrition rescreening should be implemented. | Prepare | Test | 0.61 |
| Protein Requirements Histidine is a conditionally essential amino acid for neonates and infants up to 6 months of age and should be specifically supplemented. | Prescribe | Prevent | 0.71 |
| Each parenteral nutrition formulation compounded should be inspected for signs of gross particulate contamination, discoloration, particulate formation, and phase separation at the time of compounding and before administration. | Perform Therapeutic Procedure | Perform Therapeutic Procedure | 1 |
| For individuals without symptoms or a history of cancer, the guideline developers recommend against the use of serial chest x-rays (CXRs) to screen for the presence of lung cancer. | Test | Test | 1 |
| Diagnosis of Primary TumorIn patients with a central lesion who present with or without hemoptysis, sputum cytology (at least three specimens) is a reasonable first step (in centers with a formal program directed at the acquisition, handling, and interpretation of sputum samples) in the diagnostic workup. | Test | Test | 1 |
| In patients with a positron-emission tomography (PET) scan that is positive in the mediastinum, confirmation should be obtained by an invasive test that allows sampling of the PET-positive nodes with a high sensitivity and a low FN rate. In general, mediastinoscopy is likely to be the best test. | Test | Test | 1 |
| All patients undergoing resection for stage I NSCLC (IA and IB) should have intraoperative systematic surgical mediastinal lymph node evaluation for accurate pathologic staging. | Test | Test | 1 |
| Patients with stage IIIA (N2) lung cancer identified preoperatively have a relatively poor prognosis when treated with surgery as a single modality. Several small trials of induction chemotherapy have yielded conflicting results about its effect on survival. The relative roles of surgery and radiation therapy as the local treatment modality are also not clearly defined. Definitive treatment recommendations are difficult to make in this setting. Therefore, patients in this subset should be referred for multidisciplinary evaluation before embarking on definitive treatment. | Refer/Consult | Prescribe | 0.93 |
| Infants identified as having significant risk of caries or assessed to be within 1 of the risk groups listed in the original guideline document should be entered into an aggressive anticipatory guidance and intervention program provided by a dentist between 6 and 12 months of age. | Educate/Counsel | Educate/Counsel | 1 |
| Prevention:Continue preventive measures even when a patient has a pressure ulcer to prevent additional pressure areas from developing. | Prevent | Educate/Counsel | 0.47 |
| The USPSTF recommends that clinicians screen all adult patients for obesity and offer intensive counseling and behavioral interventions to promote sustained weight loss for obese adults. | Test | Test | 0.78 |
| The USPSTF recommends that clinicians screen all adult patients for obesity and offer intensive counseling and behavioral interventions to promote sustained weight loss for obese adults. | Educate/Counsel | Test | 0.78 |
| The USPSTF recommends that clinicians screen all adult patients for obesity and offer intensive counseling and behavioral interventions to promote sustained weight loss for obese adults. | Test | Educate/Counsel | 0.22 |
| The USPSTF recommends that clinicians screen all adult patients for obesity and offer intensive counseling and behavioral interventions to promote sustained weight loss for obese adults. | Educate/Counsel | Educate/Counsel | 0.22 |
| Skin inspection should occur regularly; the frequency of inspections should be determined in response to changes in the individual's condition in relation to both deterioration or recovery. | Monitor | Monitor | 1 |
| Recommend patients with wounds and LEAD seek care guided by a clinical wound expert. | Refer/Consult | Refer/Consult | 0.6 |
| Recommend patients with wounds and LEAD seek care guided by a clinical wound expert. | Refer/Consult | Perform Therapeutic Procedure | 0.23 |
| Evaluate the patient for the presence of risk factors for heart failure. | Test | Test | 0.46 |
| Evaluate the patient for the presence of risk factors for heart failure. | Test | Prescribe | 0.49 |
| School personnel involved in detection of head lice infestation should be appropriately trained. The importance and difficulty of correctly diagnosing an active head lice infestation should be acknowledged. Schools should examine any lice related policies they may have with this in mind. | Prepare | Prepare | 1 |
| Buteyko Breathing Techniques may be helpful in reducing reliever use and improving quality of life, but this will involve a considerable cost to the patient. | Educate/Counsel | Educate/Counsel | 1 |
| Use the bed only for sleeping (or sex). | Educate/Counsel | Educate/Counsel | 0.69 |
| Develop a nursing plan tailored to the patient's presenting problem(s) and risk factors. | Prepare | Inquire | 0.25 |
| Develop a nursing plan tailored to the patient's presenting problem(s) and risk factors. | Prepare | Prepare | 0.34 |
| Develop a nursing plan tailored to the patient's presenting problem(s) and risk factors. | Prepare | Educate/Counsel | 0.24 |
| Infants and children with eating disorders should receive an oromotor assessment by an occupational therapist, speech therapist, nurse, or physician with training in pediatric oromotor dysfunction. | Test | Prepare | 0.96 |
| Patients with good PS (i.e., ECOG level 0 or 1) should be considered for a platinum-based chemotherapy regimen based on the survival advantage provided over best supportive care (BSC). | Prescribe | Prescribe | 1 |
| Treatment of Extensive-Stage SCL First-Line Treatment Patients achieving a complete remission (CR) should be offered prophylactic cranial irradiation (PCI). | Perform Therapeutic Procedure | Perform Therapeutic Procedure | 0.96 |
| Opioids should be used for patients with OA or RA when other medications and nonpharmacologic interventions produce inadequate pain relief and the patientâ??s quality of life is affected by the pain. Morphine, oxycodone, hydrocodone, or other mu agonist opioids, as a single agent or combined with an NSAID or with acetaminophen, should be used for moderate to severe OA or RA pain that has not responded to other treatments. The use of codeine and propoxyphene should be avoided because of their side effects and limited analgesic effectiveness. | Prescribe | Prescribe | 1 |
| All patients should receive education on the importance of lifestyle changes (e.g., engaging in regular weight-bearing exercise, quitting smoking, avoiding excessive alcohol intake), as well as vitamin D and calcium supplementation. | Educate/Counsel | Educate/Counsel | 1 |
| All patients should receive education on the importance of lifestyle changes (e.g., engaging in regular weight-bearing exercise, quitting smoking, avoiding excessive alcohol intake), as well as vitamin D and calcium supplementation. | Prescribe | Educate/Counsel | 1 |
| Parents should be advised that home cardiorespiratory monitoring has not been proven to prevent sudden unexpected deaths in infants. | Educate/Counsel | Educate/Counsel | 0.93 |
| Further treatment with efalizumab is not recommended in patients unless their psoriasis has responded adequately at 12 weeks . | Prescribe | Prescribe | 1 |
| Serological screening for hepatitis B surface (HBs) antigen and antibody (HBs Ag, anti-HBs IgG) should be done within 6 months pre-vaccination for all, except newborns. Hepatitis B vaccinations, except for newborns, should be given at months 0, 1, and 6, and anti-HBs IgG should be checked within 3 months after the booster dose at month 6. For newborns, vaccinations are given at months 0, 1, and 5. Newborns of hepatitis B virusâ??infected mothers who are hepatitis B e antigen (HBeAg) positive should also be given hepatitis B immunoglobulin at birth. | Prevent | Prevent | 0.98 |
| Serological screening for hepatitis B surface (HBs) antigen and antibody (HBs Ag, anti-HBs IgG) should be done within 6 months pre-vaccination for all, except newborns. Hepatitis B vaccinations, except for newborns, should be given at months 0, 1, and 6, and anti-HBs IgG should be checked within 3 months after the booster dose at month 6. For newborns, vaccinations are given at months 0, 1, and 5. Newborns of hepatitis B virusâ??infected mothers who are hepatitis B e antigen (HBeAg) positive should also be given hepatitis B immunoglobulin at birth. | Test | Prevent | 0.98 |
| In anthracycline-naive patients, who would ordinarily be offered treatment with a single-agent anthracycline (doxorubicin or epirubicin) or an anthracycline in a standard combination, the following options are also reasonable:Treatment with single-agent docetaxel 100 mg/m2 over one hour every three weeks.Docetaxel or paclitaxel in combination with doxorubicin. | Prescribe | Prescribe | 1 |
| Patients should have adequate, accurate information regarding factors that influence HIV transmission and methods for reducing the risk for transmission to others, emphasizing that the most effective methods for preventing transmission are those that protect noninfected persons against exposure to HIV (e.g., sexual abstinence; consistent and correct use of condoms made of latex, polyurethane or other synthetic materials; and sex with only a partner of the same HIV serostatus). HIV-infected patients who engage in high-risk sexual practices (i.e., capable of resulting in HIV transmission) with persons of unknown or negative HIV serostatus should be counseled to use condoms consistently and correctly. | Educate/Counsel | Educate/Counsel | 1 |
| Intra-oral devices are an appropriate therapy for snorers and for patients with mild OSAHS with normal daytime alertness. | Prescribe | Prescribe | 0.99 |
| The following recommendations are based primarily on consensus and expert opinion:In addition to health risks and benefits, patient counseling should include consideration of how oophorectomy may relate to the individual patient's body image, perceptions concerning sexuality, and personal feelings. | Educate/Counsel | Educate/Counsel | 1 |
| The treatment of choice for anovulatory uterine bleeding is medical therapy with oral contraceptives. | Prescribe | Prescribe | 1 |
| Laparoscopic myomectomy appears to be a safe and effective option for women with a small number of moderately sized uterine leiomyomas who do not desire future fertility. Further studies are necessary to evaluate the safety of this procedure for women planning pregnancy. | Perform Therapeutic Procedure | Prepare | 1 |
| Laparoscopic myomectomy appears to be a safe and effective option for women with a small number of moderately sized uterine leiomyomas who do not desire future fertility. Further studies are necessary to evaluate the safety of this procedure for women planning pregnancy. | Prepare | Prepare | 1 |
| Pregnant patients with a history of isolated venous thrombosis directly related to a transient, highly thrombogenic event (orthopedic trauma, complicated surgery) in whom an underlying thrombophilia has been excluded may be offered heparin prophylaxis or no prophylaxis during the antepartum period. However, they should be counseled that their risk of thromboembolism is likely to be higher than the normal population. Prophylactic warfarin should be offered for 6 weeks postpartum. | Educate/Counsel | Prescribe | 1 |
| Pregnant patients with a history of isolated venous thrombosis directly related to a transient, highly thrombogenic event (orthopedic trauma, complicated surgery) in whom an underlying thrombophilia has been excluded may be offered heparin prophylaxis or no prophylaxis during the antepartum period. However, they should be counseled that their risk of thromboembolism is likely to be higher than the normal population. Prophylactic warfarin should be offered for 6 weeks postpartum. | Prescribe | Prescribe | 1 |
| Available evidence does not support a recommendation for or against moderate caloric restriction in obese women with gestational diabetes mellitus (GDM). However, if caloric restriction is used, the diet should be restricted by no more than 33% of calories. | Educate/Counsel | Test | 0.28 |
| Available evidence does not support a recommendation for or against moderate caloric restriction in obese women with gestational diabetes mellitus (GDM). However, if caloric restriction is used, the diet should be restricted by no more than 33% of calories. | Educate/Counsel | Educate/Counsel | 0.34 |
| Available evidence does not support a recommendation for or against moderate caloric restriction in obese women with gestational diabetes mellitus (GDM). However, if caloric restriction is used, the diet should be restricted by no more than 33% of calories. | Educate/Counsel | Perform Therapeutic Procedure | 0.32 |
| Daily calcium supplementation has not been shown to prevent preeclampsia and, therefore, is not recommended. | Prescribe | Prescribe | 0.99 |
| Raloxifene is appropriate therapy for women with established osteoporosis to prevent osteoporotic fractures. | Prescribe | Prescribe | 0.99 |
| The best or initial treatment for hirsutism, ovulation induction, or prevention of long-term metabolic sequelae for women with PCOS is unknown. All of these conditions may benefit from lifestyle modification as initial treatment. | Educate/Counsel | Prescribe | 1 |
| For women at or beyond 36 weeks of gestation with a first episode of HSV occurring during the current pregnancy, antiviral therapy should be considered. | Prescribe | Prescribe | 1 |
| Neuroimaging should be considered in children with an abnormal neurologic examination (e.g., focal findings, signs of increased intracranial pressure, significant alteration of consciousness), the co-existence of seizures, or both. | Test | Test | 1 |
| Pediatricians should create a variety of ways for children and families to serve as advisorsâ??as members of child or family advisory councils, committees, and task forces dealing with operational issues in hospitals, clinics, and office-based practices; as participants in quality improvement initiatives; as educators of staff and professionals in training; and as leaders or coleaders of peer support programs. | Advocate | Advocate | 1 |
| Pediatricians should undertake assessment and improvement activities necessary to maximize their practices' effectiveness in immunizing children. | Prepare | Prepare | 1 |
| Encourage public and private sources to direct funding toward research into effective strategies to prevent overweight and obesity and to maximize limited family and community resources to achieve healthful outcomes for youth. | Advocate | Advocate | 1 |
| Practitioners should follow the post-operative rehabilitation protocol recommended by the orthopaedic surgeon. | Perform Therapeutic Procedure | Perform Therapeutic Procedure | 0.93 |
| Lifestyle modifications may aid in the prevention of onychomycosis. Modifications consist of wearing properly fitting shoes, using shower shoes in community showers, washing feet daily with soap and water, wearing hosiery made of synthetic materials, and supplying manicurist with personal pedicure/manicure tools . | Educate/Counsel | Educate/Counsel | 1 |
| Females aged between 1 and 2 years presenting with fever without source should be considered at risk for having a urinary tract infection. | Conclude | Test | 0.95 |
| An intravenous bolus followed by continuous-infusion proton-pump inhibitor is effective in decreasing rebleeding in patients who have undergone successful endoscopic therapy. | Prescribe | Prescribe | 1 |
| Although the available evidence suggests a lower VAP rate with passive humidification than with active humidification, other issues related to the use of passive humidifiers (resistance, dead space volume, airway occlusion risk) preclude a recommendation for the general use of these devices. The decision to use a passive humidifier should not be based solely on infection control considerations. | Prescribe | Perform Therapeutic Procedure | 0.96 |
| Autologous transplantation is recommended for patients with advanced-stage myeloma and good performance status. The evidence is strongest for patients under 65 years of age without significant renal dysfunction following hydration and remission-induction chemotherapy. Physicians must use their clinical judgment in recommending transplantation to patients over 65 years of age or those with renal impairment. | Perform Therapeutic Procedure | Prescribe | 1 |
| Autologous transplantation is recommended for patients with advanced-stage myeloma and good performance status. The evidence is strongest for patients under 65 years of age without significant renal dysfunction following hydration and remission-induction chemotherapy. Physicians must use their clinical judgment in recommending transplantation to patients over 65 years of age or those with renal impairment. | Conclude | Prescribe | 1 |
| Abdominal paracentesis should be performed and ascitic fluid should be obtained from inpatients and outpatients with clinically apparent new-onset ascites . | Perform Therapeutic Procedure | Test | 0.88 |
| The USPSTF recommends against routine screening of asymptomatic persons who are not at increased risk for syphilis infection. | Test | Test | 1 |
| Children and adolescents with newly diagnosed and/or recurrent malignancies should have their treatment coordinated by a board-certified pediatric hematologist/oncologist; treatment should be prescribed and initiated at a pediatric cancer center but may be continued at a center not specialized in the care of the pediatric oncology patient under the continuing oversight of the center's multidisciplinary team. | Transfer | Refer/Consult | 1 |
| Children and adolescents with newly diagnosed and/or recurrent malignancies should have their treatment coordinated by a board-certified pediatric hematologist/oncologist; treatment should be prescribed and initiated at a pediatric cancer center but may be continued at a center not specialized in the care of the pediatric oncology patient under the continuing oversight of the center's multidisciplinary team. | Refer/Consult | Refer/Consult | 1 |
| Roles of all the various mental health professionals who work on campus with students should be defined so that they are understood by students, families, all school staff members, and the mental health professionals themselves. | Prepare | Prepare | 1 |
| On the basis of several consistent Class II and III studies, mitoxantrone probably reduces the clinical attack rate and reduces attack-related magnetic resonance imaging (MRI) outcomes in patients with relapsing MS (Type B recommendation). The potential toxicity of mitoxantrone, however, considerably limits its use in patients with relapsing forms of MS. | Prescribe | Prescribe | 0.99 |
| In patients with suspected PH, right-heart catheterization is required to confirm the presence of PH, establish the specific diagnosis, and determine the severity of PH. | Test | Test | 1 |
| In adult patients with PAH and complex congenital heart disease who are undergoing transplantation, HLT is the procedure of choice. | Perform Therapeutic Procedure | Perform Therapeutic Procedure | 0.78 |
| The recommended dose for strontium-89 is 148 mBq (4mCi) by slow intravenous injection (1 to 2 minutes), accompanied by intravenous or oral hydration (at least 500 mL). The recommended dose for samarium-153 is 37 mBq/kg (1 mCi/kg) by slow intravenous injection (1 to 2 minutes), accompanied by intravenous or oral hydration (at least 500 mL). | Prescribe | Prescribe | 1 |
| Data concerning proper timing of office visits, CEA, and chest x-ray is insufficient to recommend one particular schedule of follow-up over another; however, office visits and CEA evaluations should be performed at a minimum of three times per year for the first two years of follow-up . | Monitor | Monitor | 1 |
| For patients with INRs of >9.0 and no significant bleeding, hold warfarin therapy and administer a higher dose of vitamin K1 (5 to 10 mg orally) with the expectation that the INR will be reduced substantially in 24 to 48 hours. Monitor the patient more frequently and use additional vitamin K1 if necessary. Resume therapy at a lower dose when INR is in the therapeutic range . | Prescribe | Prescribe | 1 |
| For patients with INRs of >9.0 and no significant bleeding, hold warfarin therapy and administer a higher dose of vitamin K1 (5 to 10 mg orally) with the expectation that the INR will be reduced substantially in 24 to 48 hours. Monitor the patient more frequently and use additional vitamin K1 if necessary. Resume therapy at a lower dose when INR is in the therapeutic range . | Monitor | Prescribe | 1 |
| For patients with symptom duration <6 hours, the guideline developers recommend the administration of alteplase or tenecteplase over streptokinase . | Prescribe | Prescribe | 1 |
| In women with prosthetic heart valves at high risk, the guideline developers suggest the addition of low-dose aspirin, 75 to 162 mg/day. | Prescribe | Prescribe | 1 |
| Perform a renal ultrasound (or repeat the ultrasound if it was done prenatally). If the patient is found to have an abnormality of the urinary tract, continue monitoring for urinary tract infections and renal function. | Monitor | Test | 0.8 |
| Perform a renal ultrasound (or repeat the ultrasound if it was done prenatally). If the patient is found to have an abnormality of the urinary tract, continue monitoring for urinary tract infections and renal function. | Test | Test | 0.8 |
| The primary care clinician should instruct patients and caregivers on how to maintain oral hygiene. | Educate/Counsel | Educate/Counsel | 0.5 |
| The primary care clinician should instruct patients and caregivers on how to maintain oral hygiene. | Educate/Counsel | Prescribe | 0.32 |
| Refer the patient for further evaluation for suspected infection, positive probe to bone, and radiographic changes demonstrating Charcot osteoarthropathy. | Refer/Consult | Test | 0.9 |
| Begin planning for the transition to adulthood with the child and family as early as possible, but no later than 12 years of age. | Prepare | Monitor | 0.28 |
| Begin planning for the transition to adulthood with the child and family as early as possible, but no later than 12 years of age. | Prepare | Conclude | 0.21 |
| Begin planning for the transition to adulthood with the child and family as early as possible, but no later than 12 years of age. | Prepare | Educate/Counsel | 0.25 |
| In patients who have a contraindication to the use of cisplatin or who experience serious toxicity from cisplatin and/or refuse treatment with cisplatin, the substitution of carboplatin for cisplatin in a taxane doublet regimen may be a reasonable treatment option. | Prescribe | Prescribe | 1 |
| Concern about increased new-onset diabetes among patients prescribed a thiazide-type diuretic with a beta-blocker means that this is not recommended as an initial combination for patients at raised risk of developing type II diabetes. | Prescribe | Prescribe | 1 |
| EEG should be used to support the classification of epileptic seizures and epilepsy syndromes when there is clinical doubt. | Test | Test | 0.99 |
| Patients with infected wounds require early and careful follow-up observation to ensure that the selected medical and surgical treatment regimens have been appropriate and effective . | Monitor | Prepare | 0.28 |
| Patients with infected wounds require early and careful follow-up observation to ensure that the selected medical and surgical treatment regimens have been appropriate and effective . | Monitor | Perform Therapeutic Procedure | 0.5 |
| The USPSTF makes no recommendation for or against screening for AAA in men aged 65 to 75 who have never smoked. | Test | Test | 1 |
| Non-occupational PEP should not be prescribed when there is negligible or low risk of HIV transmission . | Prescribe | Prescribe | 0.78 |
| Ssubstance users who wish to stop using drugs should be referred to substance abuse treatment when indicated. | Refer/Consult | Refer/Consult | 0.89 |
| Pediatricians and pediatric subspecialty providers should lead by example by taking and teaching basic life support training courses. | Prepare | Prepare | 0.98 |
| There is insufficient evidence at this time to make a recommendation regarding the use of continuous epidural infusion vs. intermittent injection in trauma patients. | Prevent | Perform Therapeutic Procedure | 0.57 |
| There is insufficient evidence at this time to make a recommendation regarding the use of continuous epidural infusion vs. intermittent injection in trauma patients. | Prevent | Prescribe | 0.43 |
| Pizotifen and nimodipine and clonidine did not show efficacy and are not recommended. | Prescribe | Prescribe | 0.99 |
| The CTFPHC concludes that there is insufficient evidence to recommend treatment of IGT with metformin or acarbose to reduce the incidence of diabetes progression . | Prescribe | Prescribe | 1 |
| Obtain a history of the client's incontinence. | Inquire | Inquire | 0.51 |
| In patients with poor liver function, TIPS is preferred to surgical therapy in the prevention of rebleeding in patients who have failed medical therapy. | Perform Therapeutic Procedure | Perform Therapeutic Procedure | 0.64 |
| In patients with poor liver function, TIPS is preferred to surgical therapy in the prevention of rebleeding in patients who have failed medical therapy. | Perform Therapeutic Procedure | Prescribe | 0.36 |
| With high-risk patients, evaluate and discuss the pros and cons of changing to a power wheelchair system as a way to prevent repetitive injuries. | Educate/Counsel | Educate/Counsel | 0.27 |
| With high-risk patients, evaluate and discuss the pros and cons of changing to a power wheelchair system as a way to prevent repetitive injuries. | Educate/Counsel | Prescribe | 0.46 |
| Erythropoietin is not recommended in situations where rapid (i.e., less than 4 weeks) recovery of hemoglobin is required. | Prescribe | Prescribe | 0.94 |
| Women should be advised that pregnancies have been reported in COC users taking non-liver enzyme-inducing antibiotics, but the evidence does not generally support reduced COC efficacy and causation. | Educate/Counsel | Educate/Counsel | 0.99 |
| Review assessment data together with the woman and identify the outcomes important to the woman and amenable to nursing intervention. | Educate/Counsel | Educate/Counsel | 1 |
| Women should be informed that the failure rate of the LNG-IUS is similar to that of modern intrauterine devices (IUDs) . | Educate/Counsel | Educate/Counsel | 0.82 |
| Clinicians should repeat CD4 or viral load results that are inconsistent with the clinical presentation before management decisions are made. | Test | Test | 0.63 |
| Either primidone or propranolol may be used as initial therapy to treat limb tremor in ET. | Prescribe | Prescribe | 1 |
| Help ensure that all adolescents have knowledge of and access to contraception including barrier methods and emergency contraception supplies. | Educate/Counsel | Prepare | 0.95 |
| Help ensure that all adolescents have knowledge of and access to contraception including barrier methods and emergency contraception supplies. | Prepare | Prepare | 0.95 |
| Antibiotics are an unnecessary addition to routine incision and drainage of uncomplicated perianal abscesses. | Prescribe | Prescribe | 0.77 |
| When assessing adherence, clinicians should use precise language that the patient can understand. In addition, clinicians should verify that patients are taking the medications as prescribed, specifically, correct medications, correct number of pills per dose, and correct number of doses per day. | Inquire | Inquire | 0.95 |
| For patients undergoing elective total hip replacement (THR), the guideline developers recommend the routine use of one of the following three anticoagulants: (1) LMWH (at a usual high-risk dose, started 12 hours before surgery or 12 to 24 hours after surgery, or 4 to 6 hours after surgery at half the usual high-risk dose and then increasing to the usual high-risk dose the following day); (2) fondaparinux (2.5 mg started 6 to 8 hours after surgery); or (3) adjusted-dose vitamin K antagonist (VKA) started preoperatively or the evening after surgery (international normalized ratio [INR] target, 2.5; INR range, 2.0 to 3.0) . | Prescribe | Prescribe | 1 |
| In women with pathological stage III tumours, bone scanning, liver ultrasonography, and chest radiography are recommended postoperatively as part of baseline staging. | Test | Test | 1 |
| If docetaxel and capecitabine are used in combination, the recommended starting dose for most patients is 950 mg/m2 twice daily of capecitabine (75% of full dose) on days 1 to 14 plus docetaxel 75 mg/m2 intravenously on day 1 of a 21-day cycle. | Prescribe | Prescribe | 1 |
| The review of raw data and the use of manual scoring for interpreting data from PM devices are recommended. | Conclude | Conclude | 0.52 |
| Although published studies have evaluated yearly screening in conjunction with mammography, clinical breast examination, and in some cases, ultrasonography, the appropriate screening interval for MRIB is not yet determined. | Monitor | Monitor | 0.89 |
| Narcotic use must be carefully titrated and supervised. | Prescribe | Prescribe | 0.6 |
| It is recommended that patients in whom discography is positive but in whom MR imaging evidence of disc degeneration is absent not be considered candidates for operative intervention. | Perform Therapeutic Procedure | Educate/Counsel | 0.84 |
| A focused exam of the hair and scalp should be performed. | Examine | Test | 1 |
| Counsel obese and overweight women about the risks of weight cycling--repeated episodes of weight loss and gain--and the benefits of adopting long-term healthy eating habits. | Educate/Counsel | Test | 0.98 |
| Critical Illness Patients with critical illnesses are at nutrition risk and should undergo nutrition screening to identify those who require formal nutrition assessment with development of a nutrition care plan. | Inquire | Educate/Counsel | 0.72 |
| Educate caregivers to assist in their ability to care for the wanderer. | Educate/Counsel | Prescribe | 0.56 |
| Vision screening should be performed at the earliest possible age and at regular intervals during childhood as recommended by the American Academy of Pediatrics (AAP). The goal remains to eliminate preventable blindness and treatable visual disability. | Monitor | Prescribe | 1 |
| Parental choice regarding management of the delivery and subsequent care of the infant should be respected within the limits of medical feasibility and appropriateness | Conclude | Advocate | 1 |
| Protein Requirements Histidine is a conditionally essential amino acid for neonates and infants up to 6 months of age and should be specifically supplemented. | Prescribe | Perform Therapeutic Procedure | 1 |
| All patients undergoing resection for stage I NSCLC (IA and IB) should have intraoperative systematic surgical mediastinal lymph node evaluation for accurate pathologic staging. | Test | Perform Therapeutic Procedure | 0.99 |
| The USPSTF recommends that clinicians screen all adult patients for obesity and offer intensive counseling and behavioral interventions to promote sustained weight loss for obese adults. | Test | Test | 1 |
| The USPSTF recommends that clinicians screen all adult patients for obesity and offer intensive counseling and behavioral interventions to promote sustained weight loss for obese adults. | Educate/Counsel | Test | 1 |
| Recommend patients with wounds and LEAD seek care guided by a clinical wound expert. | Refer/Consult | Prepare | 1 |
| School personnel involved in detection of head lice infestation should be appropriately trained. The importance and difficulty of correctly diagnosing an active head lice infestation should be acknowledged. Schools should examine any lice related policies they may have with this in mind. | Prepare | Educate/Counsel | 1 |
| Develop a nursing plan tailored to the patient's presenting problem(s) and risk factors. | Prepare | Test | 0.67 |
| Develop a nursing plan tailored to the patient's presenting problem(s) and risk factors. | Prepare | Prepare | 0.3 |
| Laparoscopic myomectomy appears to be a safe and effective option for women with a small number of moderately sized uterine leiomyomas who do not desire future fertility. Further studies are necessary to evaluate the safety of this procedure for women planning pregnancy. | Perform Therapeutic Procedure | Prevent | 0.93 |
| Laparoscopic myomectomy appears to be a safe and effective option for women with a small number of moderately sized uterine leiomyomas who do not desire future fertility. Further studies are necessary to evaluate the safety of this procedure for women planning pregnancy. | Prepare | Prevent | 0.93 |
| Pediatricians should undertake assessment and improvement activities necessary to maximize their practices' effectiveness in immunizing children. | Prepare | Advocate | 1 |
| Encourage public and private sources to direct funding toward research into effective strategies to prevent overweight and obesity and to maximize limited family and community resources to achieve healthful outcomes for youth. | Advocate | Prescribe | 1 |
| Females aged between 1 and 2 years presenting with fever without source should be considered at risk for having a urinary tract infection. | Conclude | Perform Therapeutic Procedure | 1 |
| Autologous transplantation is recommended for patients with advanced-stage myeloma and good performance status. The evidence is strongest for patients under 65 years of age without significant renal dysfunction following hydration and remission-induction chemotherapy. Physicians must use their clinical judgment in recommending transplantation to patients over 65 years of age or those with renal impairment. | Perform Therapeutic Procedure | Test | 0.7 |
| Autologous transplantation is recommended for patients with advanced-stage myeloma and good performance status. The evidence is strongest for patients under 65 years of age without significant renal dysfunction following hydration and remission-induction chemotherapy. Physicians must use their clinical judgment in recommending transplantation to patients over 65 years of age or those with renal impairment. | Conclude | Test | 0.7 |
| Autologous transplantation is recommended for patients with advanced-stage myeloma and good performance status. The evidence is strongest for patients under 65 years of age without significant renal dysfunction following hydration and remission-induction chemotherapy. Physicians must use their clinical judgment in recommending transplantation to patients over 65 years of age or those with renal impairment. | Perform Therapeutic Procedure | Perform Therapeutic Procedure | 0.3 |
| Autologous transplantation is recommended for patients with advanced-stage myeloma and good performance status. The evidence is strongest for patients under 65 years of age without significant renal dysfunction following hydration and remission-induction chemotherapy. Physicians must use their clinical judgment in recommending transplantation to patients over 65 years of age or those with renal impairment. | Conclude | Perform Therapeutic Procedure | 0.3 |
| Abdominal paracentesis should be performed and ascitic fluid should be obtained from inpatients and outpatients with clinically apparent new-onset ascites . | Perform Therapeutic Procedure | Prescribe | 1 |
| Children and adolescents with newly diagnosed and/or recurrent malignancies should have their treatment coordinated by a board-certified pediatric hematologist/oncologist; treatment should be prescribed and initiated at a pediatric cancer center but may be continued at a center not specialized in the care of the pediatric oncology patient under the continuing oversight of the center's multidisciplinary team. | Transfer | Prepare | 1 |
| Children and adolescents with newly diagnosed and/or recurrent malignancies should have their treatment coordinated by a board-certified pediatric hematologist/oncologist; treatment should be prescribed and initiated at a pediatric cancer center but may be continued at a center not specialized in the care of the pediatric oncology patient under the continuing oversight of the center's multidisciplinary team. | Refer/Consult | Prepare | 1 |
| The primary care clinician should instruct patients and caregivers on how to maintain oral hygiene. | Educate/Counsel | Test | 0.93 |
| Patients with infected wounds require early and careful follow-up observation to ensure that the selected medical and surgical treatment regimens have been appropriate and effective . | Monitor | Prepare | 1 |
| Pediatricians and pediatric subspecialty providers should lead by example by taking and teaching basic life support training courses. | Prepare | Prescribe | 0.98 |
| Pizotifen and nimodipine and clonidine did not show efficacy and are not recommended. | Prescribe | Prescribe | 1 |
| Review assessment data together with the woman and identify the outcomes important to the woman and amenable to nursing intervention. | Educate/Counsel | Perform Therapeutic Procedure | 1 |
| Help ensure that all adolescents have knowledge of and access to contraception including barrier methods and emergency contraception supplies. | Educate/Counsel | Perform Therapeutic Procedure | 0.38 |
| Help ensure that all adolescents have knowledge of and access to contraception including barrier methods and emergency contraception supplies. | Prepare | Perform Therapeutic Procedure | 0.38 |
| Help ensure that all adolescents have knowledge of and access to contraception including barrier methods and emergency contraception supplies. | Educate/Counsel | Prescribe | 0.56 |
| Help ensure that all adolescents have knowledge of and access to contraception including barrier methods and emergency contraception supplies. | Prepare | Prescribe | 0.56 |
| The review of raw data and the use of manual scoring for interpreting data from PM devices are recommended. | Conclude | Monitor | 0.65 |
| The review of raw data and the use of manual scoring for interpreting data from PM devices are recommended. | Conclude | Test | 0.35 |
| All adults and adolescents with chronic kidney disease (CKD) should be evaluated for dyslipidemias. | Test | Prescribe | 1 |
| Laparoscopic (including laparoscopically assisted) resection is recommended as an alternative to open resection for individuals with colorectal cancer in whom both laparoscopic and open surgery are considered suitable. | Perform Therapeutic Procedure | Prescribe | 1 |
| Antipsychotics should be used to treat agitation or psychosis in patients with dementia where environmental manipulation fails (Standard). Atypical agents may be better tolerated compared with traditional agents . | Prescribe | Prescribe | 1 |
| Women with uncomplicated (extended or flexed leg) breech presentation at term should be offered a caesarean after full discussion of the risks and benefits. | Perform Therapeutic Procedure | Conclude | 0.64 |
| Women with uncomplicated (extended or flexed leg) breech presentation at term should be offered a caesarean after full discussion of the risks and benefits. | Educate/Counsel | Conclude | 0.64 |
| Women with uncomplicated (extended or flexed leg) breech presentation at term should be offered a caesarean after full discussion of the risks and benefits. | Perform Therapeutic Procedure | Prescribe | 0.36 |
| Women with uncomplicated (extended or flexed leg) breech presentation at term should be offered a caesarean after full discussion of the risks and benefits. | Educate/Counsel | Prescribe | 0.36 |
| Women with one previous cesarean delivery with a low transverse incision are candidates for and should be offered a trial of labor (TOL). | Perform Therapeutic Procedure | Monitor | 0.82 |
| Individuals at high risk for developing diabetes need to become aware of the benefits of modest weight loss and participating in regular physical activity. | Educate/Counsel | Test | 1 |
| Pediatricians can actively promote bone health and support the goal of achieving adequate calcium intakes by children and adolescents by promoting the recommended adequate intakes of the Food and Nutrition Board of the National Academy of Sciences.The prevention of future osteoporosis and the possibility of a decreased risk of fractures in childhood and adolescence should be discussed with patients and families as potential benefits for achieving these goals. | Educate/Counsel | Monitor | 1 |
| Prescription or provision of emergency contraception in advance of need can increase availability and use. | Prescribe | Refer/Consult | 0.89 |
| Adhere to a checklist protocol for anesthesia machines and equipment to assure that the desired anesthetic drugs and doses will be delivered. | Prepare | Perform Therapeutic Procedure | 0.87 |
| Assess the size and the degree of intravesical prostatic protrusion (IPP) with transabdominal ultrasound scan. This information helps to predict the natural history of the disease. | Test | Educate/Counsel | 0.99 |
| Prompt investigation of the scene at which the infant was found lifeless or unresponsive and careful interviews of household members by knowledgeable individuals with the legal authority and mandate to conduct such investigations. | Inquire | Test | 0.99 |
| Prompt investigation of the scene at which the infant was found lifeless or unresponsive and careful interviews of household members by knowledgeable individuals with the legal authority and mandate to conduct such investigations. | Test | Test | 0.99 |
| Additional Laboratory Tests. It is recommended that patients with no apparent etiology of HF or no specific clinical features suggesting unusual etiologies undergo additional directed blood and laboratory studies to determine the cause of HF. | Test | Examine | 1 |
| The Task Force suggests that clinicians consider short-term testosterone therapy as an adjunctive therapy in human immunodeficiency virus (HIV)-infected men with low testosterone levels and weight loss to promote weight maintenance and gains in lean body mass (LBM) and muscle strength. | Prescribe | Perform Therapeutic Procedure | 1 |
| An EDH less than 30 cm3 and with less than a 15-mm thickness and with less than a 5-mm midline shift (MLS) in patients with a GCS score greater than 8 without focal deficit can be managed nonoperatively with serial computed tomographic (CT) scanning and close neurological observation in a neurosurgical center | Monitor | Perform Therapeutic Procedure | 0.89 |
| An EDH less than 30 cm3 and with less than a 15-mm thickness and with less than a 5-mm midline shift (MLS) in patients with a GCS score greater than 8 without focal deficit can be managed nonoperatively with serial computed tomographic (CT) scanning and close neurological observation in a neurosurgical center | Perform Therapeutic Procedure | Perform Therapeutic Procedure | 0.89 |
| Alkylating-agent based therapy is appropriate for the initial and subsequent treatment of Waldenstrom's Macroglobulinaemia. | Prescribe | Conclude | 1 |
| Epidemiology and Prevention:Clinicians should encourage all patients with HCV and all patients with HIV who are sexually active to use condoms. | Educate/Counsel | Perform Therapeutic Procedure | 1 |
| Carers: Older people who are carers of people with intellectual or other disabilities should be assessed for health and support needs. | Inquire | Prescribe | 0.85 |
| Neonates and young infants should receive appropriate pain relief. | Prevent | Test | 0.43 |
| Women with early stage (stages I and II) breast cancer who have undergone breast conservation surgery should be offered postoperative breast irradiation. | Perform Therapeutic Procedure | Prepare | 0.76 |
| Monitoring of Nutrition Support in Hospital and the Community :If long-term nutrition support is needed patients and carers should be trained to recognise and respond to adverse changes in both their well-being and in the management of their nutritional delivery system. | Educate/Counsel | Prescribe | 1 |
| HIV Screening for Pregnant Women and Their Infants:Screening should occur after a woman is notified that HIV screening is recommended for all pregnant patients and that she will receive an HIV test as part of the routine panel of prenatal tests unless she declines (opt-out screening). | Test | Conclude | 1 |
| Pelvic Examination:Recommendation:Regular gynecologic follow-up is recommended for all women. Patients who receive tamoxifen therapy are at increased risk for developing endometrial cancer and should be advised to report any vaginal bleeding to their physicians. Longer follow-up intervals may be appropriate for women who have had a total hysterectomy and oophorectomy. | Educate/Counsel | Test | 0.67 |
| Pelvic Examination:Recommendation:Regular gynecologic follow-up is recommended for all women. Patients who receive tamoxifen therapy are at increased risk for developing endometrial cancer and should be advised to report any vaginal bleeding to their physicians. Longer follow-up intervals may be appropriate for women who have had a total hysterectomy and oophorectomy. | Monitor | Test | 0.67 |
| Pelvic Examination:Recommendation:Regular gynecologic follow-up is recommended for all women. Patients who receive tamoxifen therapy are at increased risk for developing endometrial cancer and should be advised to report any vaginal bleeding to their physicians. Longer follow-up intervals may be appropriate for women who have had a total hysterectomy and oophorectomy. | Educate/Counsel | Prescribe | 0.32 |
| Pelvic Examination:Recommendation:Regular gynecologic follow-up is recommended for all women. Patients who receive tamoxifen therapy are at increased risk for developing endometrial cancer and should be advised to report any vaginal bleeding to their physicians. Longer follow-up intervals may be appropriate for women who have had a total hysterectomy and oophorectomy. | Monitor | Prescribe | 0.32 |
| Discussions should occur with the patient or legal agent about life expectancy and quality of life. | Educate/Counsel | Test | 0.92 |
| Perform a comprehensive neurological examination according to International Standards for Neurological and Functional Classification between 3 and 7 days after injury. | Examine | Prepare | 1 |
| Bi-ventricular pacemakers considered for patients requiring defibrillators who have symptomatic HF and QRS durations > 120 msec . | Perform Therapeutic Procedure | Perform Therapeutic Procedure | 0.99 |
| Pancreatitis PN should be used in patients with pancreatitis if SNS is indicated and EN is not tolerated. | Perform Therapeutic Procedure | Test | 0.93 |
| Pediatricians should be aware of the careful balance that needs to be in place to decrease the growing prevalence of eating disorders in children and adolescents. | Prepare | Prepare | 0.47 |
| Pediatricians should be aware of the careful balance that needs to be in place to decrease the growing prevalence of eating disorders in children and adolescents. | Prepare | Perform Therapeutic Procedure | 0.28 |
| Fluid and Electrolytes Water and electrolyte requirements should be adjusted in pediatric patients undergoing surgical procedures or who have on-going losses from stomas or other sites. | Prepare | Test | 1 |
| Patients with stage I NSCLC deemed medically unable to tolerate operative intervention or refusing surgical resection and having no medical contraindication to radiation therapy should receive this modality as definitive treatment. | Perform Therapeutic Procedure | Educate/Counsel | 1 |
| The USPSTF concludes that the evidence is insufficient to recommend for or against the use of counseling of any intensity and behavioral interventions to promote sustained weight loss in overweight adults. | Educate/Counsel | Test | 1 |
| Patients who are able and willing should be informed and educated about risk assessment and resulting prevention strategies. This strategy where appropriate should include carers . | Educate/Counsel | Prescribe | 0.72 |
| Head lice screening programs have not been proven to have a significant effect on the incidence of head lice in the school setting over time and are not cost-effective. Parent education programs may be helpful in the management of head lice in the school setting. | Test | Educate/Counsel | 0.92 |
| Infants and children requiring tube feedings for eating disorders should receive the minimum supplemental support necessary to maintain growth and development. | Perform Therapeutic Procedure | Prescribe | 1 |
| Combination platinum-based chemotherapy can be administered safely and with acceptable and manageable toxicity profiles in patients with good PS who have stage IV NSCLC. | Prescribe | Prescribe | 1 |
| A selective estrogen receptor modulator (SERM) has been approved by the FDA for the prevention and treatment of osteoporosis in menopausal women. A bone disease specialist should participate in the decision to choose a SERM in patients with GI diseases. | Refer/Consult | Monitor | 1 |
| Mononuclear cell (leukocyte) immunization and intravenous immune globulin (IVIG) are not effective in preventing recurrent pregnancy loss. | Prevent | Prescribe | 0.93 |
| Mononuclear cell (leukocyte) immunization and intravenous immune globulin (IVIG) are not effective in preventing recurrent pregnancy loss. | Prescribe | Prescribe | 0.93 |
| Diuretic-sensitive patients should preferably be treated with sodium restriction and oral diuretics rather than with serial paracenteses . | Prescribe | Educate/Counsel | 0.99 |
| Diuretic-sensitive patients should preferably be treated with sodium restriction and oral diuretics rather than with serial paracenteses . | Educate/Counsel | Educate/Counsel | 0.99 |
| Children and adolescents with newly suspected and/or recurrent malignancy should be referred to a pediatric cancer center for prompt and accurate diagnosis and management. | Refer/Consult | Prescribe | 0.99 |
| Aphthous Ulcers Clinicians should manage aphthous ulcers with topical corticosteroids and anesthetics. | Prescribe | Refer/Consult | 0.68 |
| Refer high-risk patients to foot care specialists for ongoing preventive care and lifelong surveillance. | Refer/Consult | Prepare | 0.55 |
| Refer high-risk patients to foot care specialists for ongoing preventive care and lifelong surveillance. | Refer/Consult | Advocate | 0.44 |
| There is some class I and adequate class II evidence to indicate that paravertebral or extrapleural infusions are effective in improving subjective pain perception and may improve pulmonary function. | Perform Therapeutic Procedure | Prescribe | 1 |
| Sumatriptan nasal spray is effective and should be considered for the acute treatment of migraine in adolescents. | Prescribe | Monitor | 1 |
| The use of prostaglandins for cervical ripening or induction of labor in most women with a previous cesarean delivery should be discouraged. | Prescribe | Conclude | 0.99 |
| Erythropoietin is recommended as a reasonable treatment option in patients in whom a slow decline in hemoglobin is associated with increased fatigue and perceived reductions in quality of life. | Prescribe | Test | 1 |
| Nurses will assess and evaluate vascular access devices for occlusion in order to facilitate treatment and improve client outcomes. | Test | Inquire | 1 |
| Children with tyrosinemia who develop hepatocellular carcinoma (HCC) and meet the criteria for liver transplantation for HCC should be high-priority candidates . | Conclude | Perform Therapeutic Procedure | 1 |
| Be aware of options and resources for adolescents and advocate for comprehensive medical and psychosocial support for all pregnant adolescents in the community. | Advocate | Refer/Consult | 1 |
| Be aware of options and resources for adolescents and advocate for comprehensive medical and psychosocial support for all pregnant adolescents in the community. | Prepare | Refer/Consult | 1 |
| Clinicians should reassess potential barriers to adherence at least every 3 to 4 months and whenever adherence problems are identified. | Monitor | Prescribe | 1 |
| The routine use of Type 4 PM devices with oximetry and at least one other airflow parameter is not recommended in an attended setting to both increase and decrease the probability that a patient has an AHI greater than 15. | Test | Test | 1 |
| Women with uncomplicated breech at 37 to 40 weeks should be offered external cephalic version (ECV) to increase the likelihood of cephalic presentation and vaginal birth. | Perform Therapeutic Procedure | Educate/Counsel | 1 |
| The opinions and experiences of lung cancer patients and carers should be collected and used to improve the delivery of lung cancer services. Patients should receive feedback on any action taken as a result of such survey. | Prepare | Monitor | 1 |
| The opinions and experiences of lung cancer patients and carers should be collected and used to improve the delivery of lung cancer services. Patients should receive feedback on any action taken as a result of such survey. | Inquire | Monitor | 1 |
| The opinions and experiences of lung cancer patients and carers should be collected and used to improve the delivery of lung cancer services. Patients should receive feedback on any action taken as a result of such survey. | Educate/Counsel | Monitor | 1 |
| Clinicians should routinely assess HIV-infected patients' smoking status and readiness to quit. | Inquire | Prepare | 1 |
| Assess patient/caregiver ability and compliance for outpatient therapy and need for home care resources. | Inquire | Perform Therapeutic Procedure | 0.99 |
| Surgery is indicated in patients who fail or are unable to comply with medical therapy and may be combined with cataract removal for enhanced visual rehabilitation . | Perform Therapeutic Procedure | Perform Therapeutic Procedure | 0.93 |
| The best initial treatment for the fetus is the provision of optimum resuscitation of the mother and the early assessment of the fetus. | Perform Therapeutic Procedure | Prescribe | 1 |
| Clinicians should assess adherence and be alert for signs of hepatotoxicity in HIV-infected patients receiving HAART who are concurrently using recreational drugs. | Test | Prescribe | 1 |
| Clinicians should assess adherence and be alert for signs of hepatotoxicity in HIV-infected patients receiving HAART who are concurrently using recreational drugs. | Inquire | Prescribe | 1 |
| Distinguish between acute otitis media (AOM) and otitis media with effusion (OME) in making therapeutic decisions. | Conclude | Prepare | 0.98 |
| Accurate history taking by emergency responders and medical personnel at the time of death and immediate transmission of this historical information to the medical examiner or coroner. | Inquire | Perform Therapeutic Procedure | 1 |
| Static lumbar radiographs are not recommended as a stand-alone means to assess fusion status following lumbar arthrodesis surgery. | Test | Test | 1 |
| Screening for autonomic neuropathy should be instituted at diagnosis of type 2 diabetes and 5 years after the diagnosis of type 1 diabetes. Special electrophysiological testing for autonomic neuropathy is rarely needed and may not affect management and outcomes. | Test | Perform Therapeutic Procedure | 0.29 |
| ACTH is probably effective for the short-term treatment of infantile spasms and in resolution of hypsarrhythmia . | Prescribe | Perform Therapeutic Procedure | 1 |
| Start aspirin 75 to 162 mg/day and continue indefinitely in all patients unless contraindicated. | Prescribe | Prescribe | 1 |
| The Task Force recommends against screening for androgen deficiency in the general population. | Test | Perform Therapeutic Procedure | 0.99 |
| Patients who have previously received rituximab and who have achieved a response of at least one year's duration to the last rituximab administration and who are appropriate candidates for chemotherapy should receive this chemotherapy in combination with rituximab. | Prescribe | Prescribe | 1 |
| Public health programs and primary care providers should adopt strategies appropriate for the practice setting to ensure that all adults at risk for HBV infection are offered hepatitis B vaccine. | Prepare | Prescribe | 0.74 |
| Omalizumab is more effective than placebo at helping to reduce or withdraw inhaled steroids and at reducing asthma exacerbations . | Prescribe | Test | 0.89 |
| Women who have not undergone optimal surgical staging can be offered two options. The first option is that they undergo reoperation to optimally define the tumour stage and then be offered adjuvant therapy based on the findings. The other option is that they be offered platinum-based chemotherapy to decrease the risk of recurrence and improve survival. | Test | Test | 0.5 |
| Women who have not undergone optimal surgical staging can be offered two options. The first option is that they undergo reoperation to optimally define the tumour stage and then be offered adjuvant therapy based on the findings. The other option is that they be offered platinum-based chemotherapy to decrease the risk of recurrence and improve survival. | Prescribe | Test | 0.5 |
| Women who have not undergone optimal surgical staging can be offered two options. The first option is that they undergo reoperation to optimally define the tumour stage and then be offered adjuvant therapy based on the findings. The other option is that they be offered platinum-based chemotherapy to decrease the risk of recurrence and improve survival. | Test | Educate/Counsel | 0.21 |
| Women who have not undergone optimal surgical staging can be offered two options. The first option is that they undergo reoperation to optimally define the tumour stage and then be offered adjuvant therapy based on the findings. The other option is that they be offered platinum-based chemotherapy to decrease the risk of recurrence and improve survival. | Prescribe | Educate/Counsel | 0.21 |
| Assessors and Multidisciplinary Teams:: Assessors of older people should be part of (or have ready access to) a wider multidisciplinary team (MDT) to whom they can quickly refer the older person for more in-depth assessment or for help in any particular domain. | Refer/Consult | Prevent | 1 |
| Recognize the signs and symptoms of pesticide exposures (both acute and chronic). | Conclude | Educate/Counsel | 0.9 |
| The decision to include bevacizumab in 5-FU-based regimens requires discussion with the patient regarding risks of added toxicity and potential benefit. | Educate/Counsel | Perform Therapeutic Procedure | 1 |
| Women should be monitored for signs and symptoms of congestive heart failure during treatment with trastuzumab. | Monitor | Test | 0.89 |
| Clinical Evaluation:Women of childbearing age presenting to the ED with abdominal pain and/or vaginal bleeding will receive a urine test for pregnancy at triage . | Test | Educate/Counsel | 0.51 |
| Clinical Evaluation:Women of childbearing age presenting to the ED with abdominal pain and/or vaginal bleeding will receive a urine test for pregnancy at triage . | Test | Prescribe | 0.31 |
| Arterial reconstructive surgery is a treatment option only in healthy individuals with recently acquired erectile dysfunction secondary to a focal arterial occlusion and in the absence of any evidence of generalized vascular disease . | Perform Therapeutic Procedure | Prepare | 1 |
| Sufficient anesthesia should be provided to prevent intraoperative pain and stress responses to decrease postoperative analgesic requirements. | Prevent | Monitor | 1 |
| Viscosupplementation may have a role in the treatment of knee pain due to osteoarthritis during the initial 12 weeks in the hands of physicians technically proficient in arthrocentesis. | Perform Therapeutic Procedure | Prescribe | 0.94 |
| Early Postoperative Management: Fluid and electrolyte management in elderly patients should be monitored regularly. | Monitor | Monitor | 1 |
| Thyroid function tests (TFTs) are not indicated in asymptomatic pregnant women with slightly enlarged thyroid glands. | Test | Test | 0.35 |
| Thyroid function tests (TFTs) are not indicated in asymptomatic pregnant women with slightly enlarged thyroid glands. | Test | Prepare | 0.62 |
| Electroencephalogram (EEG) It is recommended that patients with an apparent first unprovoked seizure be considered for neurologic evaluation after consultation between the parents and treating physician. Neurologic consultation may be more beneficial in situations where the diagnosis is equivocal after a thorough history and physical or in cases of persistent parental anxiety. | Refer/Consult | Prepare | 0.99 |
| The U.S. Preventive Services Task Force (USPSTF) strongly recommends screening for cervical cancer in women who have been sexually active and have a cervix. | Test | Prepare | 0.88 |
| Pediatricians should be familiar with the screening and counseling guidelines for disordered eating and other related behaviors. | Prepare | Prepare | 0.23 |
| Pediatricians should be familiar with the screening and counseling guidelines for disordered eating and other related behaviors. | Prepare | Perform Therapeutic Procedure | 0.27 |
| Assessing an individual's risk of developing pressure ulcers should involve both informal and formal assessment procedures. | Test | Test | 0.73 |
| Patients who have begun a course of treatment with efalizumab at the date of publication of this guidance should have the option of continuing to receive treatment until the patients and their clinicians consider it is appropriate to stop. | Prescribe | Perform Therapeutic Procedure | 1 |
| The following recommendations are based primarily on consensus and expert opinion (Level C): Epidural anesthesia appears to be safe in women taking unfractionated low-dose heparin if the APTT is normal. | Prevent | Prescribe | 1 |
| The screening test generally should be performed on venous plasma or serum samples using well-calibrated and well-maintained laboratory instruments. | Test | Prevent | 0.95 |
| Pediatricians should support and implement the Standards for Child and Adolescent Immunization Practices as endorsed by the AAP and the National Vaccine Advisory Committee . | Prepare | Educate/Counsel | 0.59 |
| Pediatricians should support and implement the Standards for Child and Adolescent Immunization Practices as endorsed by the AAP and the National Vaccine Advisory Committee . | Advocate | Educate/Counsel | 0.59 |
| Pediatricians should support and implement the Standards for Child and Adolescent Immunization Practices as endorsed by the AAP and the National Vaccine Advisory Committee . | Prepare | Prescribe | 0.21 |
| Pediatricians should support and implement the Standards for Child and Adolescent Immunization Practices as endorsed by the AAP and the National Vaccine Advisory Committee . | Advocate | Prescribe | 0.21 |
| Outcomes-based research should be performed on the effectiveness of various school-based mental health models that are designed to improve psychosocial and academic outcomes. | Prepare | Prescribe | 1 |
| PAH patients with New York Heart Association (NYHA) functional class III and IV symptoms should be referred to a transplant center for evaluation and listing for LT or heart-lung transplantation (HLT). | Refer/Consult | Conclude | 0.6 |
| PAH patients with New York Heart Association (NYHA) functional class III and IV symptoms should be referred to a transplant center for evaluation and listing for LT or heart-lung transplantation (HLT). | Refer/Consult | Prescribe | 0.4 |
| Check the adolescent annually for scoliosis and kyphosis. | Monitor | Refer/Consult | 0.94 |
| The full series should be given (initial dose and a second dose 6 to 12 months later) to ensure maximal antibody response. | Prevent | Monitor | 0.23 |
| The full series should be given (initial dose and a second dose 6 to 12 months later) to ensure maximal antibody response. | Prevent | Test | 0.75 |
| Be aware of risk factors associated with cerebral palsy and incorporate neuromotor screening into routine developmental surveillance. | Monitor | Prescribe | 1 |
| Be aware of risk factors associated with cerebral palsy and incorporate neuromotor screening into routine developmental surveillance. | Prepare | Prescribe | 1 |
| Basic life support training for the aforementioned groups should be advocated in policy advisory discussions at all governmental levels with a goal of making the training readily available and affordable. | Advocate | Prescribe | 1 |
| Ibuprofen is effective and should be considered for the acute treatment of migraine in children. | Prescribe | Monitor | 1 |
| Organizations establish a corporate policy for least restraint that includes components of physical and chemical restraints. | Prepare | Conclude | 0.73 |
| Consider a medical and rehabilitative approach to initial treatment in most instances of nontraumatic upper limb injury among individuals with SCI. | Conclude | Prescribe | 0.84 |
| The dosages of propranolol and primidone may need to be increased by 12 months of therapy when treating limb tremor in ET. | Prescribe | Prepare | 0.72 |
| Assess the adolescent mother's abilities to care for her children and have resources available for referral and assistance before neonatal discharge . | Inquire | Perform Therapeutic Procedure | 1 |
| Assess the adolescent mother's abilities to care for her children and have resources available for referral and assistance before neonatal discharge . | Prepare | Perform Therapeutic Procedure | 1 |
| The use of Type 4 PM devices in the unattended setting with oximetry and one other airflow parameter is not recommended for diagnosing OSA or confirming that a patient has an AHI greater than or less than 15. | Test | Prepare | 1 |
| GH therapy is best accomplished under the direct supervision of a clinical endocrinologist. Short-term GH treatment is safe in both children and adults. Continued monitoring of side effects and long-term treatment results is needed. | Refer/Consult | Test | 1 |
| GH therapy is best accomplished under the direct supervision of a clinical endocrinologist. Short-term GH treatment is safe in both children and adults. Continued monitoring of side effects and long-term treatment results is needed. | Monitor | Test | 1 |
| Laparoscopic colorectal surgery should be performed only by surgeons who have completed appropriate training in the technique and who perform this procedure often enough to maintain competence. The exact criteria to be used should be determined by the relevant national professional bodies. Cancer networks and constituent Trusts should ensure that any local laparoscopic colorectal surgical practice meets these criteria as part of their clinical governance arrangements. | Prepare | Test | 0.21 |
| Laparoscopic colorectal surgery should be performed only by surgeons who have completed appropriate training in the technique and who perform this procedure often enough to maintain competence. The exact criteria to be used should be determined by the relevant national professional bodies. Cancer networks and constituent Trusts should ensure that any local laparoscopic colorectal surgical practice meets these criteria as part of their clinical governance arrangements. | Prepare | Educate/Counsel | 0.73 |
| CC treatment generally should be limited to the minimum effective dose and to no more than six ovulatory cycles. Failure to conceive after successful CC-induced ovulation is indication for further evaluation to exclude other contributing causes of infertility. | Test | Prescribe | 1 |
| CC treatment generally should be limited to the minimum effective dose and to no more than six ovulatory cycles. Failure to conceive after successful CC-induced ovulation is indication for further evaluation to exclude other contributing causes of infertility. | Prescribe | Prescribe | 1 |
| Patients with hypertension should also undergo measurement of serum potassium and plasma aldosterone concentration/plasma renin activity ratio. | Test | Educate/Counsel | 0.23 |
| Patients with hypertension should also undergo measurement of serum potassium and plasma aldosterone concentration/plasma renin activity ratio. | Test | Prescribe | 0.62 |
| Soy and isoflavone intake over prolonged periods may improve lipoprotein profiles and protect against osteoporosis. | Prescribe | Educate/Counsel | 0.99 |
| Identify maternal and infant risk factors that may impact the mother's or infant's ability to breastfeed effectively and provide appropriate assistance and follow-up . | Test | Prescribe | 0.98 |
| Identify maternal and infant risk factors that may impact the mother's or infant's ability to breastfeed effectively and provide appropriate assistance and follow-up . | Educate/Counsel | Prescribe | 0.98 |
| Testosterone therapy without concomitant estrogen therapy cannot be recommended becasue there are no data on the safety and efficacy of testosterone therapy in women not using concomitant estrogen. | Prescribe | Perform Therapeutic Procedure | 0.92 |
| Ergogenic aids and nontherapeutic use of supplements for weight management should be prohibited . | Prescribe | Prepare | 0.94 |
| Perform initial comprehensive history and physical examination; consider conditions predisposing to deep vein thrombosis (DVT). | Inquire | Inquire | 0.99 |
| Perform initial comprehensive history and physical examination; consider conditions predisposing to deep vein thrombosis (DVT). | Test | Inquire | 0.99 |
| Perform initial comprehensive history and physical examination; consider conditions predisposing to deep vein thrombosis (DVT). | Conclude | Inquire | 0.99 |
| School policies should address all foods and snacks consumed on- and off-premises during school hours. | Prepare | Prepare | 1 |
| Esophageal pH recording is indicated to evaluate patients with either normal or equivocal endoscopic findings and reflux symptoms that are refractory to proton pump inhibitor therapy (pH study done after withholding antisecretory drug regimen for >= 1 week if the study is done to confirm excessive acid exposure or while taking the antisecretory drug regimen if symptom-reflux correlation is to be scored). | Test | Prescribe | 1 |
| Strong evidence including meta-analyses indicates that there is a small survival benefit of cisplatin-based chemotherapy over best supportive care in patients with non-small cell lung cancer and good performance status. | Prescribe | Refer/Consult | 1 |
| Hysteroscopic methods of tubal occlusion are still under evaluation and should only be used within the present guidance system for new surgical interventions. | Perform Therapeutic Procedure | Test | 1 |
| Women who are planning pregnancy or who have become pregnant should have a comprehensive eye examination and should be counseled on the risk of development and/or progression of diabetic retinopathy. Eye examinations should occur in the first trimester with close follow-up throughout pregnancy and for 1 year postpartum. This guideline does not apply to women who develop gestational diabetes mellitus (GDM) because such individuals are not at increased risk for diabetic retinopathy. | Monitor | Prescribe | 0.34 |
| Women who are planning pregnancy or who have become pregnant should have a comprehensive eye examination and should be counseled on the risk of development and/or progression of diabetic retinopathy. Eye examinations should occur in the first trimester with close follow-up throughout pregnancy and for 1 year postpartum. This guideline does not apply to women who develop gestational diabetes mellitus (GDM) because such individuals are not at increased risk for diabetic retinopathy. | Educate/Counsel | Prescribe | 0.34 |
| Women who are planning pregnancy or who have become pregnant should have a comprehensive eye examination and should be counseled on the risk of development and/or progression of diabetic retinopathy. Eye examinations should occur in the first trimester with close follow-up throughout pregnancy and for 1 year postpartum. This guideline does not apply to women who develop gestational diabetes mellitus (GDM) because such individuals are not at increased risk for diabetic retinopathy. | Examine | Prescribe | 0.34 |
| Assess the older person for cognitive capacity and social support. | Inquire | Prescribe | 1 |
| Elevation and debridement is recommended as the surgical method of choice. | Perform Therapeutic Procedure | Prescribe | 1 |
| Patients performing haemodialysis at home and their carers will require initial training and an accessible and responsive support service. The support service should offer the possibility of respite hospital/satellite unit dialysis as required. | Prepare | Prevent | 1 |
| Assess fitness for duty and employability by comparing the patient's work capacity to workplace demands. Obtain a functional capacity examination if needed. | Test | Educate/Counsel | 0.23 |
| Assess fitness for duty and employability by comparing the patient's work capacity to workplace demands. Obtain a functional capacity examination if needed. | Examine | Educate/Counsel | 0.23 |
| Evidence from a comparative cohort study suggests that hyperfractionated accelerated radiation therapy (HART) also improves survival over standard radiotherapy. | Perform Therapeutic Procedure | Prepare | 1 |
| Painless administration of analgesics and anesthetics should be practiced when possible. | Prevent | Examine | 1 |
| Nurses will advocate that clients with a BMI greater than or equal to 25 and a waist circumference over 102 cm (men) and 88 cm (women) consider weight reduction strategies. | Educate/Counsel | Prescribe | 1 |
| Hand-held Doppler ultrasound may be used to assess symptomatic trauma patients with suspected deep vein thrombosis. Confirmatory venography may be needed in patients who screen positive for deep vein thrombosis with Doppler ultrasound. | Test | Prevent | 1 |
| The panel recommends the following:Development of an adequate testing procedure for gluten in foods and definition of standards for gluten-free foods in the United States to lay the foundation for rational food labeling. | Prepare | Perform Therapeutic Procedure | 1 |
| Clinical Evaluation:Women with positive urine pregnancy tests who have not previously had an intrauterine pregnancy document by ultrasound will receive quantitative beta-hCG testing and a formal endovaginal ultrasound. | Test | Perform Therapeutic Procedure | 1 |
| Recommendation :Alcohol-based rubs are preferred for hand decontamination. An alternative is hand-washing with antimicrobial soap. | Prepare | Conclude | 1 |