This statement summarizes the current U.S. Preventive Services Task Force (USPSTF) recommendations on screening for coronary heart disease and the supporting scientific evidence and updates the 1996 recommendations on this topic. The complete information on which this statement is based, including evidence tables and references, is available in the background article and the systematic evidence review, available through the USPSTF Web site (http://www.preventiveservices.ahrq.gov) and through the National Guideline Clearinghouse (http://www.guideline.gov). The article and the recommendation statement are also available in print through the Agency for Healthcare Research and Quality Publications Clearinghouse (telephone, 800-358-9295; e-mail, ahrqpubs@ahrq.gov).

Primary health care visits offer opportunities to identify and intervene with risky or harmful drinkers to reduce alcohol consumption.

This statement summarizes the U.S. Preventive Services Task Force (USPSTF) recommendations on behavioral counseling interventions to reduce alcohol misuse in primary care patients and updates the 1996 recommendations on this topic. The complete information on which this statement is based, including evidence tables and references, is available in the accompanying article in this issue and in the systematic evidence review on this topic. The complete USPSTF recommendation statement (which includes a brief review of the supporting evidence), the accompanying journal article, and the complete systematic evidence review are available through the USPSTF Web site (http://www.preventiveservices.ahrq.gov). The journal article and the USPSTF recommendation statement are available in print through the Agency for Healthcare Research and Quality Publications Clearinghouse (telephone, 800-358-9295; e-mail, ahrqpubs@ahrq.gov).

A response to proton-pump inhibitors (PPIs) is commonly considered to support the diagnosis of gastroesophageal reflux disease (GERD). However, the accuracy of this diagnostic strategy has not been well established.

Hepatitis C virus (HCV) is the most common bloodborne pathogen in the United States and is an important cause of patient morbidity and mortality, but it is unclear whether screening to identify asymptomatic infected persons is appropriate.

Family and intimate partner violence is common in the United States and is often associated with acute and chronic health problems. Although the clinician's role in identification and intervention is considered a professional, ethical, and sometimes legal responsibility, the effectiveness of screening is uncertain.

This statement summarizes the U.S. Preventive Services Task Force (USPSTF) recommendations on screening for family and intimate partner violence, based on the USPSTF's examination of evidence specific to family and intimate partner violence, and updates the 1996 recommendations on this topic. In 1996, the USPSTF found insufficient evidence to recommend for or against the use of specific instruments to detect domestic violence (a grade C recommendation, according to 1996 grade definitions). The USPSTF now uses an explicit process in which the balance of benefits and harms is determined exclusively by the quality and magnitude of the evidence. As a result, current letter grades are based on different criteria from those in 1996. The complete information on which this statement is based, including evidence tables and references, is available in the accompanying article in this issue and in the summary of the evidence and systematic evidence review on the USPSTF Web site (http://www.preventiveservices.ahrq.gov) and through the National Guideline Clearinghouse (http://www.guideline.gov). The USPSTF recommendation, the accompanying summary article, and the complete systematic evidence review are available through the USPSTF Web site (http://www.preventiveservices.ahrq.gov). The summary article and the USPSTF recommendation statement are available in print through the Agency for Healthcare Research and Quality Publications Clearinghouse (telephone, 800-358-9295; e-mail, ahrqpubs@ahrq.gov).

The introduction of new agents and regimens for the treatment of chronic hepatitis C, such as pegylated interferons and combination therapy with ribavirin, has resulted in substantial improvements in sustained virologic response rates. However, treatment remains a challenge, particularly for certain patient populations, because several virus-related and patient-related factors are associated with a lower virologic response to therapy. Hepatitis C virus genotype 1 and a high baseline viral load are the major viral factors associated with lower response. Patient-related factors include previous relapse or nonresponse to treatment, the presence of cirrhosis, African-American ethnicity, older age, contraindications to treatment, and obesity. This article reviews the data on interferon-based therapies among patients with lower chances for sustained virologic response and discusses the potential of the new pegylated interferons.

Patient care for the practicing physician increasingly relies on medical devices. The U.S. Food and Drug Administration is responsible for the safety and effectiveness of medical devices in the United States. In addition to playing a role in the clinical use of devices, physicians may also participate in their design, production, use, and safety by expressing their need for certain products, by providing practical input and feedback into product design, by participating in device-related research, and by reporting device-related adverse events. Physicians should understand the rules that govern the approved and unapproved use of medical devices as well as device premarket evaluation and approval processes and device postmarket surveillance.

Allergic rhinitis is an increasingly common disease, with a prevalence of at least 10% to 25% in the United States. Diagnostic allergy tests, such as skin tests and in vitro tests, can assist clinicians in determining whether nasal symptoms are allergic in origin. In addition, safe and effective medications are available to treat allergic rhinitis. The initial strategy should be to determine whether patients should undergo diagnostic testing or receive empirical treatment. This paper reviews the test characteristics of the history, skin tests, and in vitro tests in diagnosing allergic rhinitis from the perspective of decision thresholds. A combination of pertinent medical history features in a practice with a high baseline prevalence of allergic rhinitis justifies the common practice of empirical treatment since allergy medication has minimal toxicity and side effects. The situation is more complex when the patient needs a diagnostic test, because reported sensitivities and specificities of skin tests and in vitro tests vary widely. As a result, it is difficult to calculate the post-test probability of allergic rhinitis with any confidence. The decision to initiate diagnostic testing must rely on clinical judgment to select patients who would benefit most from determining their allergic status while minimizing unnecessary testing and medications. Diagnosing allergy to a specific antigen allows patients to avoid the allergen and makes them candidates for allergen immunotherapy, which can decrease the need for medications.

Both diabetes mellitus and alcohol consumption are prevalent in the United States, yet physicians are poorly informed about how alcohol use affects risk for or management of diabetes.

Studies of diagnostic accuracy are subject to different sources of bias and variation than studies that evaluate the effectiveness of an intervention. Little is known about the effects of these sources of bias and variation.

Low-molecular-weight heparin has greatly simplified the management of deep venous thrombosis. However, for patients who present with pulmonary embolism, the role of low-molecular-weight heparin is uncertain and unfractionated heparin remains widely used.