Below is information about articles being published in Annals of Internal Medicine. The information is not intended to substitute for the full article as a source of information. Annals of Internal Medicine attribution is required for all coverage.
The Center for Disease Control and Preventionís Advisory Committee on Immunization Practices (ACIP) announced its recommended 2014 adult immunization schedule. The ACIP is comprised of the American College of Physicians and 16 other medical societies representing various medical practice areas. Each year, the ACIP reviews the CDCís Recommended Adult Immunization Schedule to ensure the schedule reflects current clinical recommendations for licensed vaccines. The recommendations are intended to guide physicians and other clinicians about the appropriate vaccines for their adult patients.
Key changes and updates for 2014:
The complete Schedule is being simultaneously published in Annals of Internal Medicine and on the Centers for Disease Control and Prevention (CDC) web site at www.cdc.gov/vaccines. Additional guidance for the use of the vaccines and updates can be found at www.cdc.gov/vaccines/hcp/acip-recs/index.html.
A survey of more than 700 general internists and family physicians shows that many barriers exist to achieving recommended adult vaccination delivery. The results are being published in Annals of Internal Medicine (http://www.annals.org/article.aspx?doi=10.7326/M13-2332). Vaccination rates in adults are low and more than 95 percent of the 30,000 Americans who die of vaccine-preventable disease each year are adults. Researchers designed a mail and internet-based survey to find out the following: physician practices for assessing vaccination status in their patients and stocking recommended vaccines; barriers to vaccination; characteristics of practices reporting financial barriers to delivering vaccines; and practices regarding vaccination by alternate vaccinators. Ninety-seven percent of physicians reported assessing their patientsí vaccination status at annual visits, but only about 30 percent did so at every visit. Cost was the biggest barrier to stocking needed vaccines and most physicians said they referred patients to an alternate vaccinator, such as a retail pharmacy or clinic, for vaccines they did not stock. Financial barriers were more likely to be a problem for small practices (fewer than five providers), being in the Southern region, and having a higher proportion of patients with Medicare Part D (for general internists only). Physicians reported getting vaccination information on their patients from several different sources and communication between physicians and alternate vaccinators was suboptimal. Use of electronic health records to report and prompt vaccination was low. The authors suggest that improving communication between primary care physicians and alternate vaccinators, more widespread use of effective tools, and removing policy-related barriers could improve adult vaccination in the United States.
The fecal immunochemical test (FIT), a stool test that is taken at home and then sent to a lab for analysis, will detect about 79 percent of colorectal cancers (CRC), according to an evidence review being published in Annals of Internal Medicine. CRC is the second leading cause of cancer death in the United States, yet one in three adults is not adequately screened. Fecal occult blood tests (FOBTs) have been associated with a 15 to 33 percent decrease in CRC mortality rates but concerns have been raised about their effectiveness as a screening tool. Unlike older stool tests, FIT does not require people to restrict their diets or to stop taking medications. Conducted annually, the test detects small amounts of blood in the stool, and people who test positive are much more likely to have colorectal cancer. People who have a positive FIT need a follow-up colonoscopy to look for cancer or pre-cancerous polyps. Researchers reviewed 19 published studies of eight different FITs to determine their diagnostic accuracy for CRC and to identify factors affecting their performance characteristics. The evidence review found that the FITs were fairly sensitive. On average, the FITs detected 79 percent of colorectal cancers with only one round of testing. The tests were also highly specific. On average, 94 percent of people who did not have cancer tested negative with a single FIT. No brand performed markedly better than another, but the authors caution that there was only one study comparing brands head-to-head. Most of the FITs required collection of only one stool sample. Brands requiring two or three stool samples were no more accurate than those requiring only one sample.
Following mammography screening guidelines, such as the United States Preventive Services Task Force (USPSTF), that base screening frequency on the best available evidence could save billions of dollars a year according to an article being published in Annals of Internal Medicine. The frequency and appropriate age to start mammography screening for have been a source of controversy in the United States, especially since the USPSTF recommended a change from annual to biennial mammography starting at age 50 instead of 40. The USPSTF guidelines conflict with professional organizations, such as the American Cancer Society, that recommend annual screening beginning at age 40. However, the USPSTF guidelines are based on a rigorous review of screening trials and work from the Cancer Intervention and Surveillance Modeling Network investigation that demonstrated that there is little net benefit in increasing the frequency of mammography screening. The cost tradeoffs of different screening recommendations are unknown. Researchers developed a computer simulation to estimate the population-level cost of three screening strategies: annual screening for women aged 40 to 84; biennial screening for women aged 50 to 69; and biennial screening for women aged 50 to 74 and personalized screening based on risk factors/comorbid conditions for women younger than 50 or older than 74 (USPSTF recommendations). The simulation showed that annual screening would cost an estimated $10.1 billion per year ($2.3 billion more than current practice). Biennial screening would cost $2.6 billion a year, and following the USPSTF guidelines would cost $3.5 billion a year. The authors suggest that money saved could be invested in personalized risk-based screening and prevention strategies. The authors of an accompanying editorial applaud the study and write that approaches to optimizing breast cancer screening should include educating women about the potential benefits, harms, and costs of different screening approaches.