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6 Guidance for Clinicians on Exposure Determination, PFAS Testing, and Clinical Follow-Up
Pages 142-153

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From page 142...
... Although close monitoring and exposure mitigation might prevent or lessen the severity of health effects for those exposed to PFAS, aggressive clinical follow-up could lead to unnecessary treatment, with attendant risk of treatment-related adverse effects; increase patients' anxiety; and even provide false assurance. For these reasons, trust and clear communication between clinicians and patients are of the utmost importance as they face the task of making decisions that consider all options and incorporate informed preferences, although how best to include children, especially adolescents, in shared decision making is a complicated matter and an active focus of research (Boland et al., 2019)
From page 143...
... Despite this variation, a key common theme across all frameworks is the need to assess whether the expected benefits of population screening exceed the potential harms. This assessment can be challenging when significant scientific uncertainty exists, as is the case for population screening for PFAS exposure.
From page 144...
... Guidance for clinicians' engagement in sharing decision making with their patients regarding follow-up care for PFAS-associated health outcomes is included later in this chapter. Clinical Practice Guidelines for PFAS-Associated Health Outcomes The committee reviewed clinical practice guidelines for the health effects associated with PFAS exposure, as well as the recommendations from the C-8 Medical Panel (see Table 6-1)
From page 145...
... Screen pregnant persons for hypertension and preeclampsia Screen pregnant persons for hypertension and throughout pregnancyk,l proteinuria throughout pregnancy Liver enzyme alterations in children and adults No routine screening recommended No screening recommended for C-8 class memberse Testicular cancer in adults American Academy of Family Physicians (AAFP) and USPSTF Screen for testicular cancer with a physical exam and recommend against screening asymptomatic adolescents and adults questionnaire for testicular cancerm Thyroid dysfunction in adults Screen newborns as part of recommended uniform Screen adults' serum thyroid-stimulating hormone; screening paneln otherwise test based on signs and symptoms of thyroid dysfunction No routine screening recommendedo Ulcerative colitis in adults No routine screening recommended Screen for symptoms with questionnaire starting at age 15 years aIn cases in which conflicting or differing recommendations for population-level screenings have been issued, the clinical practice guideline developers have been identified for clarity.
From page 146...
... Urinalysis is effective at finding blood in the urine, which can be a sign of advanced kidney cancer but is also indicative of other disorders, such as infections and kidney stones. The C-8 Medical Panel recommends that clinicians ask about family history, symptoms of kidney cancer (gross hematuria, chronic abdominal pain, recent involuntary weight loss, unexplained fever for 1 week)
From page 147...
... Elevations are often found incidentally with multiphasic blood test panels administered as part of routine medical care or as part of an assessment of patient symptoms or concerns. Elevated liver enzymes have many causes, the most common of which include use of over-thecounter pain medications (particularly acetaminophen)
From page 148...
... RECOMMENDATIONS FOR PATIENT FOLLOW-UP Where appropriate, the committee developed recommendations for patient follow-up for PFASassociated health outcomes that should be offered to patients based on shared, informed decision making between patient and clinician. The clinical practice guidelines for standard medical care and the C-8 Medical Panel recommendations served as the basis of these recommendations.
From page 149...
... Guidance for Clinicians on Exposure Determination, PFAS Testing, and Clinical Follow-Up 149 FIGURE 6-1 Clinical guidance for follow-up with patients after PFAS testing. NOTE: MeFOSAA = methylperfluorooctane sulfonamidoacetic acid; PFDA = perfluorodecanoic acid; PFHxS = perfluorohexane sulfonic acid, PFNA = perfluorononanoic acid; PFOA = perfluorooctanoic acid; PFOS = perfluorooctanesulfonic acid; PFUnDA = perfluoroundecanoic acid.
From page 150...
... . The committee's patient follow-up recommendations should be updated as clinical practice guidelines change and as more is learned about the health effects of PFAS.
From page 151...
... Guidance for Clinicians on Exposure Determination, PFAS Testing, and Clinical Follow-Up 151 FIGURE 6-2 Flow chart on how the committee's recommendations work together in a clinical setting. NOTE: ATSDR = Agency for Toxic Substances and Disease Registry; MeFOSAA = methylperfluorooctane sulfonamidoacetic acid; PFDA = perfluorodecanoic acid; PFHxS = perfluorohexane sulfonic acid, PFNA = perfluorononanoic acid; PFOA = perfluorooctanoic acid; PFOS = perfluorooctanesulfonic acid; PFUnDA = perfluoroundecanoic acid.
From page 152...
... 2019. 2018 AHA/ACC/AACVPR/ AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.
From page 153...
... USPSTF (U.S. Preventive Services Task Force)


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