Below is information about articles being published in the September 3 issue of Annals of Internal Medicine. The information is not intended to substitute for the full articled as a source of information. Annals of Internal Medicine attribution is required for all coverage.
Peer-led Facebook groups are an acceptable and effective tool for increasing home-based HIV testing among at-risk populations. HIV infection is a major health concern for men who have sex with men (MSM), especially among African Americans and Latinos who have high rates of incident cases and new diagnoses. Online social networking has grown exponentially in this population, suggesting that social media platforms could be used to relay HIV prevention messages. This is important because those who seek sex online may be at increased risk for HIV. Sixteen peer leaders were randomly assigned to deliver information about HIV (intervention, n = 57) or general health (control, n = 55) via closed Facebook groups to Los Angeles-based MSM, more than 85 percent of whom were African American or Latino. After accepting a request to join the group, participation was voluntary and all online interactions were monitored to assess participation and engagement. Throughout the trial, participants in either group could request a free, home-based HIV testing kit. Participation in messaging was high in both groups throughout the trial. After 12 weeks, more intervention participants had requested an HIV testing kit than control participants (44 percent vs 20 percent, respectively). In both groups, the median number of sexual partners decreased during the trial.
The United States Preventive Services Task Force (USPSTF) found insufficient evidence to recommend for or against using the ankle-brachial index (ABI) as a screening test for peripheral artery disease (PAD) in asymptomatic adults. PAD is a common circulatory problem in which narrowed arteries reduce blood flow to the limbs. In addition to morbidity directly caused by PAD, patients have an increased risk for cardiovascular disease (CVD) events. Screening asymptomatic patients could reduce patient morbidity and mortality by identifying patients who are at hidden risk for CVD. The ABI is the ratio of the ankle and brachial systolic blood pressure that has been used as a marker for PAD. In 2005, the Task Force recommended against using ABI as a screening test for PAD because there was little evidence that screening would improve outcomes any more than treatment based on standard CVD risk assessment. To inform the update, researchers assessed new evidence on the ability of the ABI to predict cardiovascular disease morbidity and mortality independent of the Framingham Risk Score (FRS) in asymptomatic adults. They also assessed the benefits and harms of treating adults found to have PAD through screening. The researchers found insufficient evidence to assess the balance of benefits and harms of screening for PAD and CVD risk assessment with ABI. They also found insufficient evidence to establish the benefits of treating screening-detected PAD in asymptomatic individuals.
Methylprednisolone injections significantly reduce pain and improve function in carpal tunnel syndrome (CTS) in the short term, but only slightly reduce the rate of surgery after one year. CTS is a common condition in which there is excessive pressure on the nerve in the wrist that allows feeling and movement to parts of the hand. Patients are initially treated with wrist splinting, but many go on to have surgery. While surgery often produces good outcomes, recovery can last several weeks and includes lost work time. Thus, finding an effective nonsurgical treatment is desirable. The majority of hand surgeons report using steroid injections to alleviate CTS symptoms and prevent surgery, but evidence of long-term benefit is lacking. In this randomized, placebo-controlled trial, researchers sought to determine the efficacy of local methylprednisolone injections in CTS. Three groups of 37 patients each who had CTS but no previous steroid injections were randomly assigned to receive either 80 mg of methylprednisolone, 40 mg of methylprednisolone, or placebo. At 10 weeks, patients in the 80 mg group reported the most improvement in CTS symptom severity scores. At one year, patients who received 80 mg of methylprednisolone had a lower likelihood of having surgery than those receiving 40 mg or placebo. However, three out of four patients in the trial had surgery within one year. Time from injection to surgery was longer for the 80 mg group than 40 mg or placebo.