USPSTF Recommendations That Were New or Updated in 2014.

The U.S. Preventive Services Task Force (USPSTF) is a panel of experts in screening, prevention, and evidence-based medicine. Most of its members are primary care physicians, and its recommendations are intended to guide the clinical preventive services provided by family physicians and other primary care clinicians in the outpatient setting, or referable from that setting. The USPSTF has 16 volunteer members and meets three times per year. The work of the USPSTF is supported by the Agency for Healthcare Research and Quality and federally funded Evidence-Based Practice Centers. The USPSTF addresses recommendations on more than 70 topics, including screening for disease in asymptomatic persons, behavioral counseling, and primary chemoprevention. Each topic is revisited approximately every five years. In 2014, the USPSTF created or updated recommendations on a variety of topics, which are summarized in Table 1 (see page 688). Notable changes include the following: • Fluoride varnish should be applied periodically to the primary teeth of all children five years and younger, starting at the age of primary tooth eruption. • Asymptomatic pregnant women should be screened for gestational diabetes mellitus after 24 weeks’ gestation. • Adults who are overweight or obese and who have cardiovascular risk factors should receive intensive behavioral counseling to reduce the risk of cardiovascular disease. • Screening for hepatitis B virus infection should be performed in persons at increased risk. • Low-dose aspirin should be used after 12 weeks’ gestation in pregnant women who are at high risk of preeclampsia. Additionally, the USPSTF reiterated recommendations against screening for asymptomatic carotid artery disease; against screening for abdominal aortic aneurysm in women who have never smoked; and against the use of beta carotene and vitamin E supplements as a preventive measure for cardiovascular disease and cancer. Recommendations for which there is insufficient evidence to assess the benefits and harms were omitted from Table 1 to improve its clarity. These recommendations include the following: • Screening for cognitive impairment, suicide risk, or vitamin D deficiency • Screening for abdominal aortic aneurysm in women who have ever smoked • Screening for gonorrhea and chlamydia in men • Providing primary care–based interventions to prevent or reduce illicit drug use in children and adolescents • Using vitamin supplements to prevent cardiovascular disease or cancer A more detailed description of all of the recommendations, their rationale, and the methods used by the USPSTF are available at http://www. uspreventiveservicestaskforce.org. Physicians can access the Electronic Preventive Services Selector (ePSS), a free point-of-care tool that can be used on smartphones, tablets, or computers, at http://epss.ahrq.gov/PDA/index.jsp, as well as a free eBook with the full recommendation statements at http://www.ahrq. gov/professionals /clinicians-providers/ guidelines-recommendations/guide/.