Examples of Practice Recommendations

The following practice recommendations were current at their date of approval. However, AAFP can not guarantee that they will remain valid indefinitely. Please cross check with other sources if you feel the recommendation is outdated or additional information has become available. These recommendations are intended as examples only, not necessarily as current best evidence.

The AAFP CME Division recommends the Strength of Recommendation Taxonomy (SORT) to label key recommendations in clinical review articles. While we will accept other strength of recommendations, we are moving toward using SORT as our primary explanation of a recommendation's validity. Please visit SORT for more information.

Practice Recommendation: Avoid the use of beta-carotene supplements, either alone or in combination, for the prevention of cancer or cardiovascular disease.

Name of AAFP-Approved Source: US Preventive Services Task Force (USPSTF)

Specific Web site of Supporting Evidence from Approved Source:
http://www.ahrq.gov/clinic/uspstf/uspsvita.htm

Strength of Evidence: The USPSTF recommends against routinely providing the service to asymptomatic patients. The USPSTF found at least fair evidence that the service is ineffective or that harms outweigh benefits.

Approval Date: 03/06



Practice Recommendation: Temporal lobectomy is an effective treatment for resistant epilepsy.

Name of AAFP-Approved Source: Agency for Healthcare Research and Quality Clinical Guidelines and Evidence Reports (AHRQ)

Specific Web Site of Supporting Evidence from Approved Source:
http://www.ahrq.gov/clinic/epcsums/epilsum.htm.

Strength of Evidence: Threshold analysis of retrospective data suggest that 2 years after temporal lobe surgery, 55 percent of patients are completely seizure-free, and 68 percent are free of complex partial seizures.

Approval Date: 03/06



Practice Recommendation: The US Preventive Services Task Force strongly recommends that clinicians routinely screen all sexually active women aged 35 years and younger and other asymptomatic women at increased risk for infection, for chlamydial infection.

Name of AAFP-Approved Source: US Preventive Services Task Force (USPSTF)

Specific Web Site of Supporting Evidence from Approved Source:
www.ahrq.gov/clinic/uspstf/uspschlm.htm

Strength of Evidence: The USPSTF found good evidence that screening women at risk for chlamydial infection reduces the incidence of pelvic inflammatory disease and fair evidence that community-based screening reduces prevalence of chlamydial infection. The USPSTF concludes that the benefits of screening substantially outweigh the potential harms.

Approval Date: 01/06



Practice Recommendation: DPNB is the most effective treatment for circumcision pain.

Name of AAFP-approved source: Cochrane

Specific Web site of Supporting Evidence from Approved Source:
http://www.cochrane.org/reviews/en/ab004217.html

Strength of Evidence: Thirty-five trials involving 1,984 newborns.

Approval Date: 05/06



Practice Recommendation: Osteoporosis screening is recommended for women aged 65 or older. Screening should begin at age 60 for women at increased risk of osteoporotic fractures.

Name of AAFP-Approved Source: US Preventive Services Task Force (USPSTF)

Specific Web site of Supporting Evidence from Approved Source:
http://www.ahrq.gov/clinic/uspstf/uspsoste.htm

Strength of Evidence: The USPSTF found good evidence (B recommendation) that the risk for osteoporosis and fracture increases with age and other factors, that bone density measurements accurately predict the risk for fractures in the short-term, and that treating asymptomatic women with osteoporosis reduces their risk for fracture. The USPSTF concludes that the benefits of screening and treatment are of at least moderate magnitude for women at increased risk by virtue of age or presence of other risk factors.

Approval Date: 03/06



Practice Recommendation: A 1- to 2-week course of H. pylori eradication therapy is an effective treatment for H. pylori positive peptic ulcer disease.

Name of AAFP-Approved Source: Cochrane

Specific Web site of Supporting Evidence from Approved Source:
http://www.cochrane.org/reviews/en/ab004062.html

Strength of Evidence: 59 trials were eligible. Data extraction was not possible in 7 trials, and 52 trials were included.

Approval Date: 05/06



Practice Recommendation: Lower blood pressure in the elderly, using diuretics and beta blockers preferentially, to reduce stroke, decrease cardiovascular morbidity and mortality and reduce overall mortality.

Name of AAFP-Approved Source: Cochrane

Specific Web Site of Supporting Evidence from Approved Source:
http://cochrane.org/reviews/en/ab000028.html

Strength of Evidence: A review of fifteen trials, including 21,908 elderly subjects were identified.

Approval Date: 05/06



Practice Recommendation: Screen all adult patients for tobacco use, and institute tobacco cessation interventions for those who are identified as users of tobacco.

Name of AAFP-Approved Source: US Preventive Services Task Force (USPSTF)

Specific Web Site of Supporting Evidence from Approved Source:
www.ahrq.gov/clinic/uspstf/uspstbac.htm

Strength of Evidence: The USPSTF found good evidence that brief smoking cessation interventions, including screening, brief behavioral counseling (less than 3 minutes), and pharmacotherapy delivered in primary care settings, are effective in increasing the proportion of smokers who successfully quit smoking and remain abstinent after 1 year. Although most smoking cessation trials do not provide direct evidence of health benefits, the USPSTF found good evidence that smoking cessation lowers the risk for heart disease, stroke, and lung disease. Level A Recommendation.

Approval Date: 02/06



Practice Recommendation: All postmenopausal women should be evaluated for risk factors of osteoporosis which include increasing age, white race, low weight or weight loss, non-use of estrogen replacement, history of previous fracture, family history of fracture, history of falls, and low scores on one or more measures of physical activity and function.

Name of AAFP-Approved Source: Agency for Healthcare Research and Quality Clinical Guidelines and Evidence Reports (AHRQ)

Specific Web Site of Supporting Evidence from Approved Source:
http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=hstat1.chapter.39885

Strength of Evidence: A systematic review of 530 articles about risk factors, 123 about bone measurement tests, 23 about bone density monitoring, 277 about biochemical markers, and 53 about costs. An additional 242 studies were retrieved after reviewing reference lists of studies and by suggestion of the expert panel or leading researchers in the field.

Approval Date: 05/06



Practice Recommendation: Provide one-time ultrasound screening for aortic aneurysm to men aged 65-75 who have ever smoked.

Name of AAFP-Approved Source: US Preventive Services Task Force (USPSTF)

Specific Web Site of Supporting Evidence from Approved Source:
http://www.ahrq.gov/clinic/uspstf/uspsaneu.htm

Strength of Evidence: The USPSTF recommends that clinicians provide this service to eligible patients. The USPSTF found at least fair evidence that the service improves health outcomes and concludes that benefits outweigh harms. Level B Recommendation

Approval Date: 03/06