Assessing the clinical effectiveness of preventive maneuvers: Analytic principles and systematic methods in reviewing evidence and developing clinical practice recommendations A report by the Canadian task force on the periodic health examination

doi:10.1016/0895-4356(90)90073-X

Journal of Clinical Epidemiology

Volume 43, Issue 9, 1990, Pages 891-905

https://doi.org/10.1016/0895-4356(90)90073-X Get rights and content

Abstract

This paper examines a process for evaluating clinical effectiveness and developing recommendations in which systematic methods are used to review evidence from published clinical research and to reach sound conclusions about appropriate medical policy. The methodology addresses four important components of the analytic process: (1) the criteria that must be satisfied for a clinical practice to be considered effective; (2) proper methods for reviewing evidence from published clinical research to determine whether a clinical practice meets these criteria (including methods for performing comprehensive literature reviews, for judging the quality of individual studies, and for synthesizing or pooling the results of multiple studies); (3) theoretical and practical concerns in translating the results of the scientific review into sound clinical practice recommendations; and (4) the importance of documentation, guidelines, and other safeguards to minimize the effect the reviewers themselves have on the objectivity and consistency of the analytic methods.

References (90)

D.L. Sackett
Rules of evidence and clinical recommendations on the use of antithrombotic agents
Chest
(1986)
K.K. Shy et al.
Evaluation of elective repeat cesarean section as a standard care: an application of decision analysis
Am J Obstet Gynecol
(1981)
L.A. MacDonald et al.
Labelling in hypertension: a review of the behavioral and psychological consequences
J Chron Dis
(1984)
T. Poynard et al.
The retrieval of randomized clinical trials in liver disease from the medical literature: a comparison of MEDLARS and manual methods
Controlled Clin Trials
(1985)
T.C. Chalmers et al.
A method for assessing the quality of a randomized controlled trial
Controlled Clin Trials
(1981)
M.J. Lichtenstein et al.
Guidelines for reading case-control studies
J Chron Dis
(1987)
M. Jenicek
Meta-analysis in medicine: where we are and where we want to go
J Clin Epidemiol
(1989)
M.F. Oliver
Consensus or nonsensus conferences on coronary heart disease
Lancet
(1985)
Canadian Task Force on the Periodic Health Examination
The periodic health examination
Can Med Assoc J
(1979)
Canadian Task Force on the Periodic Health Examination
The periodic health examination. 1984 update
Can Med Assoc J
(1984)

Canadian Task Force on the Periodic Health Examination

The periodic health examination. 1986 update

Can Med Assoc J

(1986)

Canadian Task Force on the Periodic Health Examination

The periodic health examination. 1988 update

Can Med Assoc J

(1988)

Canadian Task Force on the Periodic Health Examination

The periodic health examination. 1989 update

Can Med Assoc J

(1989)

S.W. Fletcher et al.

Approach of the Canadian Task Force to the Periodic Health Examination

Ann Intern Med

(1980)

R.S. Lawrence et al.

Preventive services in clinical practice: designing the periodic health examination

JAMA

(1987)

M.S. O'Malley et al.

Screening for breast cancer with breast self-examination: a critical review

JAMA

(1987)

F.M. LaForce

Immunizations, immunoprophylaxis, and chemoprophylaxis to prevent selected infections

JAMA

(1987)

C.R. Horsburgh et al.

Preventive strategies in sexually transmitted diseases for the primary care physician

JAMA

(1987)

T.E. Kottke et al.

Attributes of successful smoking cessation interventions in medical practice: a meta-analysis of 39 controlled trials

JAMA

(1988)

M.R. Polen et al.

Automobile injury: selected risk factors and prevention in the health care setting

JAMA

(1988)

K.K. Knight et al.

Occult blood screening for colorectal cancer

JAMA

(1989)

J.V. Selby et al.

Sigmoidoscopy in the periodic health examination

JAMA

(1989)

S.S. Harris et al.

Physical activity counseling for healthy adults as a primary preventive intervention in the clinical setting: report for the U.S. Preventive Services Task Force

JAMA

(1989)

J.C. Greene et al.

Preventive dentistry, I: dental caries

JAMA

(1989)

J.C. Greene et al.

Preventive dentistry II: periodontal diseases, malocclusion, trauma, and oral cancer

JAMA

(1990)

R.S. Lawrence et al.

Report of the U.S. Preventive Services Task Force

JAMA

(1990)

Quebec Task Force on Spinal Disorders

Scientific approach to the assessment and management of activity-related spinal disorders; a monograph for clinicians

Spine

(1987)

Final report on the aspirin component of the ongoing Physicians' Health Study

N Engl J Med

(1989)

R.N. Battista et al.

Making recommendations on preventive practices: methodological issues

U.S. Department of Health and Human Services

Reducing the Health Consequences of Smoking: 25 Years of Progress. A Report of the Surgeon General

M.C. Leske

The epidemiology of open-angle glaucoma: a review

Am J Epidemiol

(1983)

R.L. Nelson et al.

Iatrogenic perforation of the colon and rectum

Dis Colon Rectum

(1982)

T.L. Campbell

Material serum alpha-fetoprotein screening: benefits, risks, and costs

J Fam Pract

(1987)

C.M. Winslow et al.

The appropriateness of carotid endarterectomy

N Engl J Med

(1988)

R.C. Lefebvre et al.

Labeling of participants in high blood pressure screening programs: implications for blood cholesterol screenings

Arch Intern Med

(1988)

A.B. Bergman et al.

The morbidity of cardiac nondisease in schoolchildren

N Engl J Med

(1967)

D. Cadman et al.

Evaluation of public health preschool child developmental screening: the process and outcomes of a community program

Am J Public Health

(1987)

J.R. Sorenson et al.

Parental response to repeat testing of infants with “false positive” results in a newborn screening program

Pediatrics

(1984)

K. Fyro et al.

Four-year follow-up of psychological reactions to false positive screening tests for congenital hypothyroidism

Acta. Paediatr Scand

(1987)

C.D. Mulrow

The medical review article: state of the science

Ann Intern Med

(1987)

C.D. Mulrow et al.

A proposal for more informative abstracts of review articles

Ann Intern Med

(1988)

D.L. Sackett et al.

Clinical Epidemiology

(1985)

R.H. Fletcher et al.

Clinical Epidemiology: the Essentials

(1988)

Cited by (230)

Prevalence of ECG abnormalities in people with type 2 diabetes: The Hoorn Diabetes Care System cohort
2021, Journal of Diabetes and its Complications
Citation Excerpt :
Screening with an ECG must not only reliably identify unrecognized CVD or determine the risk for a future CVD event, but findings must also be prevalent enough. Moreover, they must lead to clinical actions resulting in improvements in clinical outcomes that are superior to those resulting from existing preventative strategies.19,20 Both the American Diabetes Association (ADA), and the recent joint European Society of Cardiology and European Association for the Study of Diabetes (ESC/EASD) guidelines recommend to regularly perform a resting ECG in people with type 2 diabetes and hypertension or suspected CVD, without mentioning a time interval.21,22
The American Diabetes Association, and the joint European Society of Cardiology and European Association for the Study of Diabetes guidelines recommend a resting ECG in people with type 2 diabetes with hypertension or suspected cardiovascular disease (CVD). However, knowledge on the prevalence of ECG abnormalities is incomplete. We aimed to analyse the prevalence of ECG abnormalities and their cross-sectional associations with cardiovascular risk factors in people with type 2 diabetes.
We used data of the Diabetes Care System cohort obtained in 2018. ECG abnormalities were defined using the Minnesota Classification and categorised into types of abnormalities. The prevalence was calculated for the total population (n = 8068) and the subgroup of people without a history of CVD (n = 6494). Logistic regression models were used to asses cross-sectional associations.
Approximately one-third of the total population had minor (16.0%) or major (13.1%) ECG abnormalities. Of the participants without a CVD history, approximately one-quarter had minor (14.9%) or major (9.1%) ECG abnormalities, and for those with hypertension or very high CVD risk, the prevalence was 27.5% and 39.6%, respectively. ECG abnormalities were significantly and consistently associated with established CVD risk factors.
Resting ECG abnormalities are common in all people with type 2 diabetes (29.1%), including those without a history of CVD (24.0%), and their prevalence is related to traditional cardiovascular risk factors such as older age, male sex, hypertension, lower HDL cholesterol, higher BMI, and smoking behaviour.
A structured approach for optimization of pharmaceutical care in neurology including patients with epilepsy
2020, Pharmacien Hospitalier et Clinicien
Décrire la démarche de mise à niveau de l’offre de soins pharmaceutiques en neurologie en ciblant l’épilepsie.
Étude descriptive composée d’une revue de la littérature traitant des rôles et des impacts du pharmacien dans la prise en charge de l’épilepsie, d’une description de l’organisation des soins entourant les patients atteints d’épilepsie et de la mise à jour de l’offre de soins pharmaceutiques pour cette patientèle.
Quinze articles ont été inclus dans la revue de la littérature. Neuf articles mesuraient l’impact du pharmacien, tandis que six étaient descriptifs. La majorité des articles présentaient un faible niveau de preuve compte tenu de leur méthodologie. Les activités les plus mentionnées dans les articles portaient sur la proposition d’une thérapie médicamenteuse optimale et sur la réalisation de conseils aux patients. L’offre de soins pharmaceutiques a été mise à jour selon 13 nouvelles opportunités qui vont s’intégrer dans le cadre de l’offre de soins en pédiatrie.
Il existe peu de littérature sur les rôles et l’impact du pharmacien en épilepsie. Cette démarche, réalisée en collaboration avec les neurologues, met en valeur les preuves disponibles et permet d’identifier les opportunités d’arrimage médecin-pharmacien.
To describe the process of implementing pharmaceutical care in neurology (e.g. epilepsy).
A descriptive study including a literature review about the roles and the impacts of pharmacists involved in the treatment of epilepsy, a description of organization of care around patients with epilepsy and an update of the pharmaceutical care offer to these patients.
Fifteen articles were included in the literature review. Nine articles measured the impact of the pharmacists, while six were descriptive. The majority of articles had a low level of evidence. The most advanced activities in the articles focused on the optimisation of pharmacotherapy and on the provision of patient counselling. The supply of pharmaceutical care has been updated according to 13 new opportunities that are part of the paediatric care offer.
There is little literature on the roles and impact of the pharmacist involved in pharmaceutical care to patients with epilepsy. This approach was carried out in collaboration with neurologists, highlighting the available evidence and identifying the opportunities for physician-pharmacist collaboration.
Prenatal Exercise and Pre-gestational Diseases: A Systematic Review and Meta-analysis
2019, Journal of Obstetrics and Gynaecology Canada
This study sought to examine the effect of prenatal exercise on birth outcomes in women with pre-gestational diseases, including chronic hypertension, type 1 diabetes, and type 2 diabetes.
A structured search of online databases up to June 8, 2018 was conducted. Studies of all designs and languages were included if they contained information on the population (pregnant women with pre-gestational diseases), intervention (subjective or objective measures of frequency, intensity, duration, volume, or type of exercise), comparator (no exercise or different frequency, intensity, duration, volume, or type of exercise), and outcome (birth weight, macrosomia [birth weight >4000 g], large for gestational age, low birth weight [<2500 g], small for gestational age [<10th percentile], Apgar score, preterm birth [<37 weeks], Caesarean section (CS), preeclampsia, and glycemic control).
A total of five studies (n = 221 women) were included. Canadian Task Classification was designated as level I. “Low” to “very low” quality evidence revealed that prenatal exercise reduced the odds of CS by 55% in women with type 1 diabetes and chronic hypertension (OR 0.45; 95% CI 0.22–0.95, I² = 0%). The odds of low (<2500 g) or high (>4000 g) birth weight, Apgar score at 1 and 5 minutes, preeclampsia, and preterm birth were not different between women who exercised and those who did not.
Prenatal exercise reduced the odds of CS and did not increase the risk of adverse maternal or neonatal outcomes in mothers with pre-gestational medical conditions. Findings are based on limited evidence, thus suggesting a need for high-quality investigations on exercise in this population of women.
Cette étude avait pour but d'examiner les effets de l'exercice prénatal sur les issues de grossesse de femmes présentant déjà des affections avant la grossesse, dont l'hypertension chronique et le diabète, de type 1 ou de type 2.
Les auteures ont effectué une recherche structurée dans des bases de données en ligne jusqu’au 8 juin 2018. Les études étaient sélectionnées - sans restrictions de modèle ou de langue - si elles contenaient de l'information sur la population (femmes enceintes présentant des affections avant la grossesse), l'intervention (mesures subjectives ou objectives de la fréquence, de l'intensité, de la durée, du volume ou du type d'exercice), le point de comparaison (aucun exercice ou différences dans l'intensité, la durée, le volume ou le type d'exercice) et les issues (poids à la naissance, macrosomie [poids à la naissance > 4000 g], GAG, poids insuffisant à la naissance [< 2500 g], PAG [< 10^e percentile], indice d'Apgar, accouchement prématuré [< 37 semaines], césarienne, prééclampsie, et régulation glycémique).
Au total, cinq études (n = 221 femmes) ont été sélectionnées (classification I du Groupe d'étude canadien). Des données probantes de qualité ≪ faible ≫ et ≪ très faible ≫ ont révélé que l'exercice prénatal permettrait de réduire le risque de césarienne de 55 % chez les femmes présentant un diabète de type 1 ou une hypertension chronique (RC : 0,45; IC à 95 % : 0,22 à 0,95, I² = 0 %). Le risque de faible poids (< 2500 g) ou de poids élevé (> 4000 g) à la naissance, l'indice d'Apgar à une et à cinq minutes et l'incidence de prééclampsie et d'accouchements prématurés n'étaient associés à aucune différence entre les femmes qui avaient fait de l'exercice et les autres.
L'exercice prénatal a réduit le risque de césarienne sans faire augmenter le risque d'issues maternelles ou néonatales indésirables chez les femmes présentant des affections avant la grossesse. Les résultats étant fondés sur des données probantes limitées, des études de haute qualité sur l'exercice dans cette population sont donc requises.
No. 368-RUBELLA IN PREGNANCY
2018, Journal of Obstetrics and Gynaecology Canada
To review the epidemiology, natural history, evaluation, and prevention of rubella infection during pregnancy. This will aid obstetric care providers in counseling their patients regarding potentially devastating effects on the developing fetus and the importance of vaccinating susceptible women as appropriate.
Outcomes evaluated include fetal rubella infection, maternal seroconversion and response to rubella-containing vaccines.
Medline, PubMed, EMBASE, and Cochrane databases were searched for articles in English on subjects related to rubella infection during pregnancy betweenn 1985 and 2017. Results were restricted to systematic reviews, randomized controlled trials/controlled clinical trials, and observational studies. Other (unpublished) literature was identified through searching the websites of health technology assessment and health technology assessment-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies.
The quality of the evidence is rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care (Table 1). Recommendations for practice are ranked according to the method described in this Report.
The guideline will be reviewed 5 years after publication to decide if an update is required. However, if important new evidence is published prior to the 5-year cycle, the review process may be accelerated for a more rapid update of some recommendations
Society of Obstetricians and Gynaecologists of Canada.
- 1
  Screening for rubella serostatus is recommended as part of standard prenatal screening if a pregnant woman has no record of rubella past immunity and no proof of immunization against rubella (III-B).
- 2
  Since the effects of rubella infection in pregnancy vary with the gestational age at the time of infection, accurate gestational dating should be established, as well as timing of rubella infection, as they are critical to counselling (II-3A).
- 3
  In a pregnant woman exposed to rubella or who develops signs or symptoms of rubella or whose fetus presents ultrasound anomalies compatible with congenital rubella syndrome, serological testing for rubella immunoglobulin M and immunoglobulin G should be performed to determine immune status and risk of congenital rubella syndrome (III-A).
- 4
  Women should be counselled about the possible risk of vertical transmission and informed regarding the option of pregnancy termination, especially if primary infection occurs prior to 16 weeks gestation (III-A).
- 5
  Rubella immunization should not be administered in pregnancy but may be safely given postpartum, as long as there is no contraindication to receive a live vaccine (i.e., systemic immunosuppression). Consider delaying vaccination if the woman received any immunoglobulin-containing preparations, including Rh immunoglobulin or intravenous immune globulin, or blood products during pregnancy or the peripartum period, as there is potential for reduced vaccine effectiveness (III-B).
- 6
  Women who have been inadvertently vaccinated in early pregnancy or who become pregnant immediately following vaccination can be reassured that there have been no cases of congenital rubella syndrome documented in these situations (III-B).
- 7
  Women wishing to conceive should be counselled and encouraged to have their rubella antibody status determined if no record of rubella past immunity and no proof of immunization are available and undergo rubella vaccination if needed (III-B).
N<sup>o</sup> 368 - La rubéole durant la grossesse
2018, Journal of Obstetrics and Gynaecology Canada
Examiner l'épidémiologie, l'histoire naturelle, la prise en charge et la prévention de la rubéole pendant la grossesse. Cela aidera les prestataires de soins obstétricaux à conseiller leurs patientes sur les effets potentiellement dévastateurs de la rubéole sur le développement du fœtus et sur l'importance de vacciner les femmes susceptibles.
Les résultats évalués incluent l'infection congénitale par le virus de la rubéole, la séroconversion maternelle et la réponse aux vaccins contenant la rubéole.
Des recherches ont été effectuées dans les bases de données Medline, PubMed, EMBASE et Cochrane sur des articles liés à la rubéole pendant la grossesse publiés en anglais entre 1985 et 2017. Les résultats ont été limités aux revues systématiques, aux essais contrôlés randomisés / essais cliniques contrôlés et aux études d'observation. La littérature grise (non publiée) a été identifiée grâce à la recherche sur les sites Web d'agences d'évaluation des technologies de la santé et liées à ces dernières, de lignes directrices de pratique clinique, de registres d'essais cliniques et de sociétés nationales et internationales médicales.
La qualité des résultats est évaluée au moyen des critères décrits dans le rapport du Groupe d'étude canadien sur les soins de santé préventifs (Tableau 1). Les recommandations pour la pratique sont classées selon la méthode décrite dans ce rapport.
Une revue des données probantes sera menée cinq ans après la publication de la présente directive clinique afin d'évaluer si une mise à jour complète ou partielle s'impose. Si de nouvelles données probantes importantes sont publiées avant la fin de ces cinq ans, une mise à jour tenant compte des nouvelles connaissances et recommandations sera publiée.
La Société des obstétriciens et gynécologues du Canada.
- 1
  Il est recommandé de déterminer l'état sérologique pour la rubéole dans le cadre du dépistage prénatal systématique chez les femmes enceintes qui n'ont pas de documentation de leur immunité antérieure ni preuve d'immunisation contre la maladie (III-B).
- 2
  Comme les effets de la rubéole durant la grossesse diffèrent selon l’âge gestationnel au moment de l'infection, cette donnée est cruciale pour le conseil prénatal; il faut donc dater avec exactitude la grossesse et l'infection (II-3-A).
- 3
  Les femmes enceintes qui ont été exposées au virus de la rubéole, qui montrent des signes et symptômes de la maladie ou dont le fœtus présente des anomalies compatibles avec l'embryopathie rubéolique à l’échographie doivent faire l'objet d'une sérologie des immunoglobulines M et G antirubéole, qui déterminera l’état immunitaire maternel et le risque d'embryopathie rubéolique (III-A).
- 4
  Il est recommandé de conseiller les femmes quant au risque de transmission verticale et de les renseigner sur l'interruption de grossesse, particulièrement lorsqu'une infection primaire survient avant 16 semaines de grossesse (III-A).
- 5
  Le vaccin contre la rubéole ne devrait pas être administré durant la grossesse. Il est sûr après l'accouchement chez les femmes n'ayant aucune contre-indication à la réception d'un vaccin vivant (immunosuppression systémique). Il faut envisager de repousser la vaccination chez les femmes à qui on a administré une préparation contenant des immunoglobulines, par exemple des immunoglobulines anti-Rh ou des immunoglobulines intraveineuses, ou des produits sanguins durant la grossesse ou en période périnatale, car l'efficacité du vaccin pourrait s'en trouver réduite (III-B).
- 6
  Les femmes qui ont reçu le vaccin alors qu'elles ne se savaient pas enceintes ou qui sont tombées enceintes juste après la vaccination peuvent être rassurées : la littérature ne rapporte aucun d'embryopathie rubéolique survenu dans ces circonstances (III-B).
- 7
  Il faut recommander vivement aux femmes cherchant à concevoir qui n'ont pas d'infection antérieure au virus à leur dossier ou qui ne détiennent pas de preuve d'immunisation contre la maladie de subir un test de détection des anticorps antirubéole et de se faire vacciner au besoin (III-B).
No. 346-Advanced Reproductive Age and Fertility
2017, Journal of Obstetrics and Gynaecology Canada
To improve awareness of the natural age-related decline in female and male fertility with respect to natural fertility and assisted reproductive technologies (ART), provide recommendations for their management, and to review investigations in the assessment of ovarian aging.
This guideline reviews options for the assessment of ovarian reserve and fertility treatments using ART with women of advanced reproductive age presenting with infertility.
The outcomes measured are the predictive value of ovarian reserve testing and pregnancy rates with natural and assisted fertility.
Published literature was retrieved through searches of PubMed or Medline, CINAHL, and The Cochrane Library in June 2010, using appropriate key words (“ovarian aging,” “ovarian reserve,” “advanced maternal age,” “advanced paternal age,” and “assisted reproductive technology”). Results were restricted to systematic reviews, randomized controlled trials/controlled clinical trials, and observational studies. There were no date or language restrictions. Searches were updated on a regular basis and incorporated into the guideline to December 2010.
The quality of evidence was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care. Recommendations for practice were ranked according to the method described in that report.
Primary and specialist health care providers and women will be better informed about ovarian aging and the age-related decline in natural fertility and about options for ART.
- 1.
  Women in their 20s and 30s should be counselled about the age-related risk of infertility when other reproductive health issues such as sexual health or contraception are addressed as part of their primary well-woman care. Reproductive-age women should be aware that natural fertility and assisted reproductive technology success (except with egg donation) is significantly lower for women in their late 30s and 40s (II-2A).
- 2.
  Because of the decline in fertility and the increased time to conception that occur after age 35, women >35 should be referred for infertility work-up after 6 months of trying to conceive (III-B).
- 3.
  Ovarian reserve testing may be considered for women aged ≥35 or for women <35 with risk factors for decreased ovarian reserve, such as a single ovary, previous ovarian surgery, poor response to follicle-stimulating hormone, previous exposure to chemotherapy or radiation, or unexplained infertility (III-B).
- 4.
  Ovarian reserve testing prior to assisted reproductive technology treatment may be used for counselling but has a poor predictive value for non-pregnancy and should be used to exclude women from treatment only if levels are significantly abnormal (II-2A).
- 5.
  Pregnancy rates for controlled ovarian hyperstimulation are low for women aged >40. Women >40 should consider in vitro fertilization if they do not conceive within 1 to 2 cycles of controlled ovarian hyperstimulation (II-2B).
- 6.
  The only effective treatment for ovarian aging is oocyte donation. A woman with decreased ovarian reserve should be offered oocyte donation as an option because pregnancy rates associated with this treatment are significantly higher than those associated with controlled ovarian hyperstimulation or in vitro fertilization with a woman's own eggs (II-2B).
- 7.
  Women should be informed that the risk of spontaneous pregnancy loss and chromosomal abnormalities increases with age. Women should be counselled about and offered appropriate prenatal screening once pregnancy is established (II-2A).
- 8.
  Pre-conception counselling regarding the risks of pregnancy with advanced maternal age, promotion of optimal health and weight, and screening for concurrent medical conditions such as hypertension and diabetes should be considered for women aged 40 (III-B).
- 9.
  Advanced paternal age appears to be associated with an increased risk of spontaneous abortion and increased frequency of some autosomal dominant conditions, autism spectrum disorders, and schizophrenia. Men >40 and their partners should be counselled about these potential risks when they are seeking pregnancy, although the risks remain small (II-2C).

View all citing articles on Scopus

^∗: Dr Woolf is scientific advisor to the U.S. Preventive Services Task Force.

^†: Other Members of the Canadian Task Force on the Periodic Health Examination: Richard B. Goldbloom, M.D. (chairman), Marie-Dominique Beaulieu, M.D., M.Sc., John W. Feightner, M.D., William Feldman, M.D., Karen V. Mann, R.N., Ph.D., Wm. Phillip Mickelson, M.D., M.A., Brenda J. Morrison, Ph.D., M.S., Daniel Offord, M.D., Christopher Patterson, M.D., Walter O. Spitzer, M.D., M.P.H., and Jeannie Haggerty, M.Sc. (staff coordinator).

View full text

Original articleAssessing the clinical effectiveness of preventive maneuvers: Analytic principles and systematic methods in reviewing evidence and developing clinical practice recommendations A report by the Canadian task force on the periodic health examination

Abstract

Chest

Am J Obstet Gynecol

J Chron Dis

Controlled Clin Trials

Controlled Clin Trials

J Chron Dis

J Clin Epidemiol

Lancet

The periodic health examination

Can Med Assoc J

The periodic health examination. 1984 update

Can Med Assoc J

The periodic health examination. 1986 update

Can Med Assoc J

The periodic health examination. 1988 update

Can Med Assoc J

The periodic health examination. 1989 update

Can Med Assoc J

Approach of the Canadian Task Force to the Periodic Health Examination

Ann Intern Med

Preventive services in clinical practice: designing the periodic health examination

JAMA

Screening for breast cancer with breast self-examination: a critical review

JAMA

Immunizations, immunoprophylaxis, and chemoprophylaxis to prevent selected infections

JAMA

Preventive strategies in sexually transmitted diseases for the primary care physician

JAMA

Attributes of successful smoking cessation interventions in medical practice: a meta-analysis of 39 controlled trials

JAMA

Automobile injury: selected risk factors and prevention in the health care setting

JAMA

Occult blood screening for colorectal cancer

JAMA

Sigmoidoscopy in the periodic health examination

JAMA

Physical activity counseling for healthy adults as a primary preventive intervention in the clinical setting: report for the U.S. Preventive Services Task Force

JAMA

Preventive dentistry, I: dental caries

JAMA

Preventive dentistry II: periodontal diseases, malocclusion, trauma, and oral cancer

JAMA

Report of the U.S. Preventive Services Task Force

JAMA

Scientific approach to the assessment and management of activity-related spinal disorders; a monograph for clinicians

Spine

Final report on the aspirin component of the ongoing Physicians' Health Study

N Engl J Med

Making recommendations on preventive practices: methodological issues

Reducing the Health Consequences of Smoking: 25 Years of Progress. A Report of the Surgeon General

The epidemiology of open-angle glaucoma: a review

Am J Epidemiol

Iatrogenic perforation of the colon and rectum

Dis Colon Rectum

Material serum alpha-fetoprotein screening: benefits, risks, and costs

J Fam Pract

The appropriateness of carotid endarterectomy

N Engl J Med

Labeling of participants in high blood pressure screening programs: implications for blood cholesterol screenings

Arch Intern Med

The morbidity of cardiac nondisease in schoolchildren

N Engl J Med

Evaluation of public health preschool child developmental screening: the process and outcomes of a community program

Am J Public Health

Parental response to repeat testing of infants with “false positive” results in a newborn screening program

Pediatrics

Four-year follow-up of psychological reactions to false positive screening tests for congenital hypothyroidism

Acta. Paediatr Scand

The medical review article: state of the science

Ann Intern Med

A proposal for more informative abstracts of review articles

Ann Intern Med

Clinical Epidemiology

Clinical Epidemiology: the Essentials

Original article
Assessing the clinical effectiveness of preventive maneuvers: Analytic principles and systematic methods in reviewing evidence and developing clinical practice recommendations A report by the Canadian task force on the periodic health examination