‡For more information, see Broder KR, Cortese MM, Iskander JK, Kretsinger K, Slade BA, Brown KH, et al. Preventing tetanus, diphtheria, and pertussis among adolescents: use of tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccines recommendations of the Advisory Committee on Immunization Practices (ACIP). Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2006;55(RR-3):1–34.; Kretsinger K, Broder KR, Cortese MM, Joyce MP, Ortega-Sanchez I, Lee GM, et al. Preventing tetanus, diphtheria, and pertussis among adults: use of tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine recommendations of the Advisory Committee on Immunization Practices (ACIP) and recommendation of ACIP, supported by the Healthcare Infection Control Practices Advisory Committee (HICPAC), for use of Tdap among health-care personnel. Centers for Disease Control and Prevention; Advisory Committee on Immunization Practices; Healthcare Infection Control Practices Advisory Committee. MMWR Recomm Rep 2006;55(RR-17):1–37. §For more information, see Postpartum screening for abnormal glucose tolerance in women who had gestational diabetes mellitus. ACOG Committee Opinion No. 435. American College of Obstetricians and Gynecologists. Obstet Gynecol 2009;113:1419–21. From American College of Obstetricians and Gynecologists, Primary and preventive care: periodic assessments. ACOG Committee Opinion No. 452. Obstet Gynecol 2009;144:1444–1451.
not permit “even moderated certainty” about the net benefit of the preventive service. The role of judgment in the domains of the potential preventable burden of suffering from the condition, the potential harm of the intervention, the cost, the context of current practice, and the potential role of other domains are recognized by the task force, with the conclusion that “decision making under conditions of uncertainty is a recurring issue in medicine” (20).
International efforts to categorize the effectiveness of treatments include the Cochrane Library, which produces and disseminates high-quality systematic reviews of health care interventions. These reviews and abstracts are published monthly and are available online and on DVDs by subscription (21). The Cochrane Library provides searchable databases online and through institutional purchase of licenses. Evidence-based guidelines are published in journals available in print and online by discipline (i.e., medicine, mental health, and nursing). Another source of evidence-based information is Clinical Evidence, a subscription service published by the British Medical Journal in print, via PDA, and online (22). This service describes its content as driven by important clinical questions rather than by the availability of research evidence. The advantages of Web-based sites are the ease of updating and the availability of evidence to clinicians in clinical practice sites throughout the world. Other Web sites that provide tools and information about evidence-based health care include the Oxford Centre for
Table 8.6 U.S. Preventive Services Task Force Ratings
The U.S. Preventive Services Task Force (USPSTF) grades its recommendations according to one of five classifications (A, B, C, D, I) reﬂecting the strength of evidence and magnitude of net benefit (benefits minus harms). After May 2007, updated definitions of the grades it assigns to recommendations are noted below with “suggestions for practice” with each grade (50).
Evidence-Based Medicine, the Database of Abstracts of Reviews of Effects (DARE), and the American College of Physicians (ACP) Journal Club (23–25).