Canadian Task Force (CTF) - Summary Table of "C" Recommendations

Summary Table of "C" Recommendations
When Evidence is Conflicting

Please note: In 2003, the CTF updated its Grades of Recommendations to include an "I Recommendation" for situations where insufficient evidence exists to allow a recommendation to be made. (Formerly, these situations were captured under a "C Recommendation".) This change is not retroactive, and all "C Recommendations" made prior to 2003 have not been reevaluated in light of the new "I" recommendation grade. For a discussion of these recommendation grades, please link to the 2003 article in the Canadian Medical Association Journal here.

CONDITION MANEUVER POPULATION

Abdominal aortic aneurysm Abdominal palpation General population

Abdominal aortic aneurysm Abdominal ultrasound General population

Adverse consequences, children of alcoholics Routine evaluation; some screening options General population

Adverse consequences, children of alcoholics Referral school- or community-based intervention programs High-risk population

Age-related macular degeneration Fundoscopy Elderly

All-cause mortality and morbidity Counselling, physical activity; prevent obesity General population

All-cause mortality, morbidity Measure body mass index and treat obesity General population

All-cause morbidity and mortality Office contact or home-based parenting education programs Disadvantaged children

Breast cancer Screening mammography Women aged 40-49 years at average risk of breast cancer

Breast cancer follow-up Follow-up for local recurrence Women having been previously diagnosed with breast cancer

Breast cancer follow-up Follow-up for contralateral breast cancer Women having been previously diagnosed with breast cancer

Bladder cancer Urine dipstick or cytology High-risk males >60 years

Cardiovascular disease Acetylsalicylic acid prophylaxis General population

Carotid disease/ stroke Antiplatelet therapy Adults with asymptomatic carotid bruit or stenosis

Child maltreatment Comprehensive health care program Families with children

Child maltreatment Parent education and support program Families with children

Child maltreatment Combination of home-based services,
including case management,
education and psychotherapy Families with children

Child maltreatment Sexual abuse, abduction prevention programs General population

Cognitive impairment Mental status screening Elderly

Colorectal cancer Hemoccult/sigmoidoscopy in combination Average risk adults > age 50

Colorectal cancer Colonoscopy Average risk adults, high-risk adults with family history of polyps/CRC

Congenital rubella syndrome Universal vaccination Young men (living in crowded conditions)

Coronary artery disease events Screening for total plasma homocysteine levels General population or those at high risk for coronary artery disease events

Coronary artery disease events Vitamin therapy (folic acid alone or with vitamin B12) to lower total plasma homocysteine levels All populations

Coronary heart disease Diet/drug treatment Individuals with elevated cholesterol or LDL-C except males 30-59 yrs

Coronary heart disease Measurement of blood total cholesterol level General population with case-finding for males 30-59 years

Coronary heart disease General dietary advice on fat and cholesterol General population except males 30-69 years

D (Rh) sensitization Repeat D (Rh) antibody screening and immunoglobin (D Ig) administration Women undergoing specific obstetric procedures or complications

Dental caries Counselling, diet or baby bottle General and high-risk population

Developmental Hip Dysplasia Abduction therapy Normal- or high-risk infant

Developmental Hip Dysplasia Timing of abduction therapy (early intervention) - optimal duration of observation Normal- or high-risk infants

Developmental problems Developmental screening questionnaires Preschool children

Domestic violence Batterer/couples interventions General population

Elder abuse Elder abuse questionnaire Elderly

Fetal alcohol syndrome History, questionnaire, interview, clinical judgment/alcohol consumption Pregnant women

Gestational diabetes mellitus Blood glucose, fasting/random or glucose challenge test Pregnant women

Gestational diabetes mellitus History, risk factors; if positive glucose tolerance test Pregnant women

Glaucoma Fundoscopy, tonometry or automated perimetry Elderly

Group B Streptococcal Intrapartum chemoprophylaxis based on risk factors only Pregnant women

Hemoglobinopathies Screening for carrier status and counselling Adult population and non-pregnant adolescents

HIV/AIDS History, sexual and drug use counselling General population

HIV/AIDS Voluntary HIV antibody screening General population including pregnant women

Household and recreational injury Counselling, household and recreational injury (except some home hazards, poisoning for children) Children, adults, elderly

Household and recreational injury Public education/ Legislation, gun control & use of Heimlich maneuver General population

Household and recreational injury Monitor medical impairment Elderly

Household and recreational injury Public education, non-flammable fabrics, self-extinguishing cigarettes Elderly

Hypertension Pharmacologic treatment Adults aged <21 yrs, isolated systolic hypertension, some elderly subgroups

Idiopathic adolescent scoliosis Physical exam, back Adolescents

Influenza Immunization, annual General population <65 years

Influenza Rapid diagnostic test Suspected cases

Iron deficiency anemia Routine hemoglobin General population and infants

Lead exposure Universal screening (Blood lead level or questionnaire) General population

Low birth weight Iron supplementation Pregnant women

Low birth weight/preterm birth Diet supplementation Pregnant women at high risk of undernutrition

Low birth weight/preterm birth Multicomponent programs Pregnant women

MVA injury Counselling, helmet, alcohol use General population

MVA injury Monitor medical impairment General population

Neonatal herpes simplex Cesarean section Symptomatic pregnant women

Neonatal morbidity and mortality Electronic fetal monitoring, intrapartum High-risk pregnancies

Obesity BMI measurement General population

Obesity Community-based obesity prevention programs General population

Obesity Weight-reduction therapy Obese adults without obesity-related disease

Obesity Exercise and/or nutrition and behaviour modification Obese children

Obesity Height, weight, skin-fold thickness, BMI, etc. Children

Occupational low back pain Use of back belts in the workplace General population

Oral cancer - 1994 review Physical exam, oral cavity General population

Oral cancer - 1999 review Screening by clinical examination Asymptomatic patients

Otitis Media Screening to identify children with clinically important
OME (tympanometry,
microtympanometry, acoustic
reflectometry and pneumo-otoscopy) Children up to 4 years of age

Otitis Media Screening to prevent delay in language development as a
result of OME Children up to 4 years of age

Ovarian cancer Pelvic exam, transvaginal ultrasound, CA 125 or combination Pre- and post-menopausal women or family history 1st degree relative

Paroxysmal atrial fibrillation
in patients with stroke Ambulatory ECG All patients presenting with stroke or transient ischemic attack

Perinatal morbidity and mortality Ultrasound, prenatal, serial Pregnant women

Periodontal disease Brushing and flossing teeth, supervised High-risk patients

Periodontal disease Brushing with electric toothbrush Patients with limited dexterity

Periodontal disease Flossing teeth Children

Phenylketonuria Phenylalanine test Pregnant women

Pneumococcal pneumonia Immunization, one dose Immunocompetent elderly living independently

Preeclampsia Aspirin prophylaxis, low dose Pregnant women

Preterm birth Home uterine activity monitoring High-risk pregnancies

Prostate cancer Digital rectal examination Males >50 years

Protein/calorie malnutrition Protein/calorie malnutrition screening Adult population

Skin cancer Counselling, Skin self-examination General population

Skin cancer Counselling, Sun block General population

Skin cancer Physical examination, skin General population

Stroke Ambulatory ECG All patients presenting with stroke or transient ischemic attack

Stroke Echocardiography: Transthoracic (TTE) or transesophageal (TEE) for detection of intracardiac masses Patients without clinical cardiac disease

Stroke Treatment for patent foramen ovale General population

Suicide Suicide risk evaluation General population

Suicide Referral school- or community-based program High-risk population

Suicide Hospital admission, discharge home, intensive psycho-social follow-up Individuals previously attempting suicide

Testicular cancer Physical exam or self-examination Adolescent or adult males

Thyroid cancer Neck Palpation Adult population

Thyroid disorders Thyroid stimulating hormone test Perimenopausal women

Tobacco-caused disease Counselling on environmental tobacco smoke Families with smokers

Tuberculosis INH Prophylaxis General population aged >35 years

Urinary infection Urine dipstick or culture Elderly, ambulatory women

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CONDITION	MANEUVER	POPULATION
Abdominal aortic aneurysm	Abdominal palpation	General population
Abdominal aortic aneurysm	Abdominal ultrasound	General population
Adverse consequences, children of alcoholics	Routine evaluation; some screening options	General population
Adverse consequences, children of alcoholics	Referral school- or community-based intervention programs	High-risk population
Age-related macular degeneration	Fundoscopy	Elderly
All-cause mortality and morbidity	Counselling, physical activity; prevent obesity	General population
All-cause mortality, morbidity	Measure body mass index and treat obesity	General population
All-cause morbidity and mortality	Office contact or home-based parenting education programs	Disadvantaged children
Breast cancer	Screening mammography	Women aged 40-49 years at average risk of breast cancer
Breast cancer follow-up	Follow-up for local recurrence	Women having been previously diagnosed with breast cancer
Breast cancer follow-up	Follow-up for contralateral breast cancer	Women having been previously diagnosed with breast cancer
Bladder cancer	Urine dipstick or cytology	High-risk males >60 years
Cardiovascular disease	Acetylsalicylic acid prophylaxis	General population
Carotid disease/ stroke	Antiplatelet therapy	Adults with asymptomatic carotid bruit or stenosis
Child maltreatment	Comprehensive health care program	Families with children
Child maltreatment	Parent education and support program	Families with children
Child maltreatment	Combination of home-based services, including case management, education and psychotherapy	Families with children
Child maltreatment	Sexual abuse, abduction prevention programs	General population
Cognitive impairment	Mental status screening	Elderly
Colorectal cancer	Hemoccult/sigmoidoscopy in combination	Average risk adults > age 50
Colorectal cancer	Colonoscopy	Average risk adults, high-risk adults with family history of polyps/CRC
Congenital rubella syndrome	Universal vaccination	Young men (living in crowded conditions)
Coronary artery disease events	Screening for total plasma homocysteine levels	General population or those at high risk for coronary artery disease events
Coronary artery disease events	Vitamin therapy (folic acid alone or with vitamin B12) to lower total plasma homocysteine levels	All populations
Coronary heart disease	Diet/drug treatment	Individuals with elevated cholesterol or LDL-C except males 30-59 yrs
Coronary heart disease	Measurement of blood total cholesterol level	General population with case-finding for males 30-59 years
Coronary heart disease	General dietary advice on fat and cholesterol	General population except males 30-69 years
D (Rh) sensitization	Repeat D (Rh) antibody screening and immunoglobin (D Ig) administration	Women undergoing specific obstetric procedures or complications
Dental caries	Counselling, diet or baby bottle	General and high-risk population
Developmental Hip Dysplasia	Abduction therapy	Normal- or high-risk infant
Developmental Hip Dysplasia	Timing of abduction therapy (early intervention) - optimal duration of observation	Normal- or high-risk infants
Developmental problems	Developmental screening questionnaires	Preschool children
Domestic violence	Batterer/couples interventions	General population
Elder abuse	Elder abuse questionnaire	Elderly
Fetal alcohol syndrome	History, questionnaire, interview, clinical judgment/alcohol consumption	Pregnant women
Gestational diabetes mellitus	Blood glucose, fasting/random or glucose challenge test	Pregnant women
Gestational diabetes mellitus	History, risk factors; if positive glucose tolerance test	Pregnant women
Glaucoma	Fundoscopy, tonometry or automated perimetry	Elderly
Group B Streptococcal	Intrapartum chemoprophylaxis based on risk factors only	Pregnant women
Hemoglobinopathies	Screening for carrier status and counselling	Adult population and non-pregnant adolescents
HIV/AIDS	History, sexual and drug use counselling	General population
HIV/AIDS	Voluntary HIV antibody screening	General population including pregnant women
Household and recreational injury	Counselling, household and recreational injury (except some home hazards, poisoning for children)	Children, adults, elderly
Household and recreational injury	Public education/ Legislation, gun control & use of Heimlich maneuver	General population
Household and recreational injury	Monitor medical impairment	Elderly
Household and recreational injury	Public education, non-flammable fabrics, self-extinguishing cigarettes	Elderly
Hypertension	Pharmacologic treatment	Adults aged <21 yrs, isolated systolic hypertension, some elderly subgroups
Idiopathic adolescent scoliosis	Physical exam, back	Adolescents
Influenza	Immunization, annual	General population <65 years
Influenza	Rapid diagnostic test	Suspected cases
Iron deficiency anemia	Routine hemoglobin	General population and infants
Lead exposure	Universal screening (Blood lead level or questionnaire)	General population
Low birth weight	Iron supplementation	Pregnant women
Low birth weight/preterm birth	Diet supplementation	Pregnant women at high risk of undernutrition
Low birth weight/preterm birth	Multicomponent programs	Pregnant women
MVA injury	Counselling, helmet, alcohol use	General population
MVA injury	Monitor medical impairment	General population
Neonatal herpes simplex	Cesarean section	Symptomatic pregnant women
Neonatal morbidity and mortality	Electronic fetal monitoring, intrapartum	High-risk pregnancies
Obesity	BMI measurement	General population
Obesity	Community-based obesity prevention programs	General population
Obesity	Weight-reduction therapy	Obese adults without obesity-related disease
Obesity	Exercise and/or nutrition and behaviour modification	Obese children
Obesity	Height, weight, skin-fold thickness, BMI, etc.	Children
Occupational low back pain	Use of back belts in the workplace	General population
Oral cancer - 1994 review	Physical exam, oral cavity	General population
Oral cancer - 1999 review	Screening by clinical examination	Asymptomatic patients
Otitis Media	Screening to identify children with clinically important OME (tympanometry, microtympanometry, acoustic reflectometry and pneumo-otoscopy)	Children up to 4 years of age
Otitis Media	Screening to prevent delay in language development as a result of OME	Children up to 4 years of age
Ovarian cancer	Pelvic exam, transvaginal ultrasound, CA 125 or combination	Pre- and post-menopausal women or family history 1st degree relative
Paroxysmal atrial fibrillation in patients with stroke	Ambulatory ECG	All patients presenting with stroke or transient ischemic attack
Perinatal morbidity and mortality	Ultrasound, prenatal, serial	Pregnant women
Periodontal disease	Brushing and flossing teeth, supervised	High-risk patients
Periodontal disease	Brushing with electric toothbrush	Patients with limited dexterity
Periodontal disease	Flossing teeth	Children
Phenylketonuria	Phenylalanine test	Pregnant women
Pneumococcal pneumonia	Immunization, one dose	Immunocompetent elderly living independently
Preeclampsia	Aspirin prophylaxis, low dose	Pregnant women
Preterm birth	Home uterine activity monitoring	High-risk pregnancies
Prostate cancer	Digital rectal examination	Males >50 years
Protein/calorie malnutrition	Protein/calorie malnutrition screening	Adult population
Skin cancer	Counselling, Skin self-examination	General population
Skin cancer	Counselling, Sun block	General population
Skin cancer	Physical examination, skin	General population
Stroke	Ambulatory ECG	All patients presenting with stroke or transient ischemic attack
Stroke	Echocardiography: Transthoracic (TTE) or transesophageal (TEE) for detection of intracardiac masses	Patients without clinical cardiac disease
Stroke	Treatment for patent foramen ovale	General population
Suicide	Suicide risk evaluation	General population
Suicide	Referral school- or community-based program	High-risk population
Suicide	Hospital admission, discharge home, intensive psycho-social follow-up	Individuals previously attempting suicide
Testicular cancer	Physical exam or self-examination	Adolescent or adult males
Thyroid cancer	Neck Palpation	Adult population
Thyroid disorders	Thyroid stimulating hormone test	Perimenopausal women
Tobacco-caused disease	Counselling on environmental tobacco smoke	Families with smokers
Tuberculosis	INH Prophylaxis	General population aged >35 years
Urinary infection	Urine dipstick or culture	Elderly, ambulatory women