Madison Clinic
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Summary of Basic Health Maintenance/Screening

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  1. Life Habits Screening
  2. Cancer Screening
  3. Hepatitis Screening
  4. STD Screening of Asymptomatic Patients
  5. Immunizations
  6. Hyperlipidemia
  7. Diabetes
  8. Osteoporosis
  9. Abdominal aortic aneurysm
  1. Life Habits Screening

    Screen Criteria Action
    Diet/Exercise
    Nicotine addiction
    Drug/alcohol use
    Sexual Health
    Mental Health
    Domestic violence
    All Patients Yearly Identify issues, discuss, refer as appropriate:
    Dietician will see patients for evaluation and BIA every six months or, when clinically indicated, provider may refer patient for consult. Provider may refer to smoking cessation counselors, social workers, or psychiatry.

  2. Cancer Screening

    Screen Criteria Action
    Breast Cancer Women/age dependent

    AND

    MTF transgender, if on estrogen therapy

    Age 40-49: controversial whether to screen with mammography (yearly or biannual)

    Age 50+: screen every 1-2 years with mammography

    Insufficient data to recommend clinical breast exam

    Cervical Cancer All women PAP smears to begin at onset of sexual activity or age 21 years old

    If negative X 2 at six month interval, then yearly

    See Cervical Cancer guideline for management of specific abnormality

    Prostate Cancer Family hx of prostate CA or African/American heritage:
    Age≥45

    All other men≥50

    Controversial. USPSTF does not recommend for or against screening because of lack of evidence for benefit

    Counsel interested men about potential benefits and harms of early detection and treatment; consider digital rectal exam and PSA
    Colorectal Cancer Low risk: Age≥50

     

     

    Medium risk *: Age≥40

     

    High risk **: Age≥40 or 10 yrs before youngest family case (whichever comes first)

    Annual FOBT, q5yr sigmoidoscopy, q5yr sigmoidoscopy+annual FOBT, or every 10yr colonoscopy

    Same screening as above but begin at 40yo

    Every 5yr colonoscopy

    Anal Cancer Neither the USPSTF, the ACS, nor the CDC recommends screening with anal Pap smear testing at this time  

    * Patients with one first degree relative age>60 or two second degree relatives (grandparent, aunt or uncle) diagnosed with colon cancer

    ** Patients with a first degree relative (parent, sibling, or child) with colon cancer or an adenomatous polyp diagnosed at age<60 or two first degree relatives diagnosed with colorectal cancer at any age

  3. Hepatitis Screening

    Screen Criteria Action
    Hepatitis A All patients If HAV Ab negative, schedule vaccine series
    Hepatitis B All patients If HBC core and surface Ab negative, schedule vaccine series

    If HBV Sag+ schedule q6months RUQ U/S, AFP

    Hepatitis C All patients If Ab+ and PCR negative; repeat PCRx1

    If PCR +; refer for biopsy and treatment if appropriate;

    Check genotype and quantitative PCR on tx candidates

    If no tx; q 3months LFTs

    If cirrhosis, no tx but q 6months U/S and AFP

  4. STD Screening of Asymptomatic Patients

    Group Criteria Action
    MSM Sexually active in last year Annual RPR
      Oral sex in last year Annual pharyngeal gonorrhea cultures
      Receptive anal intercourse Annual rectal GC/CT
      High risk MSM* Q3-6 month RPR, rectal C/CT+pharyngeal GC
    Women Sexually active in last year Cervical GC/CT nucleic acid amplification test (NAT) or urine NAT for GC/CT; screening interval based on risk assessment of woman

    *MSM with anonymous or multiple partners , users of crystal methamphetamine or inhaled nitrites ("poppers"), or men whose sex partners participate in these activities.
  5. Immunizations

    Criteria Action
    All patients Pneumovax baseline and in 5 years

    Annual influenza

    Diphtheria/tetanus every ten years (3 dose series, if not given in childhood)

    PPD: on intake or annual if at risk (homeless or communal living)

    MMR: for patients with medical/exposure indications; if titers negative give two doses at least 28 days apart (if CD4≤200 withhold MMR or other measles containing vaccine)


  6. Hyperlipidemia

    Criteria Action
    Age≥35 or soon to initiate
    HAART
    Check lipid panel

    See lipid section in guidelines for management of specific abnormalities


  7. Diabetes

    Criteria Action
    Adults with sustained BP>135/80 and Adults with dyslipidemia

    Diabetes diagnosis page


  8. Osteoporosis
    Criteria Action
    Women 65 years and older and women aged 60-64 years at increased risk

    DEXA scan at femoral neck q2 years


  9. Abdominal aortic aneurysm
    Criteria Action
    Men aged 65-75 who have ever smoked Abdominal ultrasound x 1


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