Heidi D. Nelson, MD, MPH
Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M11-2667.
Nelson HD. Screening Women for Intimate Partner Violence. Ann Intern Med. 2012;157:676-677. doi: 10.7326/0003-4819-157-9-201211060-00020
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Published: Ann Intern Med. 2012;157(9):676-677.
A systematic review for the USPSTF is guided by an analytic framework that outlines the key questions needed to support a chain of evidence on which to build an evidence-based practice recommendation (1). For screening services, such as IPV, direct supportive evidence would come from trials comparing outcomes of individuals undergoing screening with those not screened. In the absence of sufficient direct evidence, studies addressing a series of indirect questions could also provide support. For IPV, studies of the accuracy of screening methods coupled with effectiveness trials evaluating benefits and harms of interventions address indirect questions. The goal of the systematic review is to identify and evaluate relevant studies to address both direct and indirect questions in the analytic framework. It is then up to the USPSTF to determine whether the chain of evidence is sufficient to support a recommendation based on the strength, quality, and applicability of evidence, as well as its direction and magnitude of effect. For example, the USPSTF recommendation on osteoporosis screening was based on sufficient indirect evidence because of the lack of screening trials (2).
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