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5 August 2008 Annals of Internal Medicine Tip Sheet

Annals of Internal Medicine is published by the American College of Physicians on the first and third Tuesday of every month. These highlights are not intended to substitute for articles as sources of information. For a copy of an article, call 1-800-523-1546, ext. 2656, or 215-351-2656, or visit Past highlights are accessible as well.

1. U.S. Preventive Services Task Force Updates Prostate Cancer Screening Recommendations

In an update to its 2002 recommendation, the U.S. Preventive Service Task Force (USPSTF) recommends against screening for prostate cancer in men age 75 years or older. More research is needed to determine if men younger than 75 could benefit from screening. Prostate cancer is the most common non-skin cancer and the second leading cause of cancer death in men in the United States. Measurement of prostate-specific antigen (PSA) in the blood can find prostate cancer before symptoms develop, but it is not known if early treatment actually helps patients. Most prostate cancer grows very slowly, and many men with prostate cancer die of something else before they develop problems associated with prostate cancer. Early detection, however, puts men at risk for worry and side effects of treatment. Surgery and radiation therapy, common treatments for prostate cancer, can cause problems with sexual function and cause bowel and bladder incontinence. (NOTE: A separate news release was issued.)

2. National Health and Nutritional Examination Survey Finds Chronic Illness Common Among Uninsured

A National Health and Nutritional Examination Survey (1999 - 2004) of more than 12,000 patients aged 18 to 64 concluded that an estimated 11.4 million Americans with chronic medical conditions, such as cardiovascular disease, hypertension, and diabetes, were uninsured. The survey found that chronically ill patients without insurance were less likely than those with coverage to report a physician visit within the last 12 months and more likely to report using an emergency department as a standard site for care. The authors estimated that nearly one-third of uninsured U.S. adults had at least one chronic condition. However, authors say that given the limited access to care among those without insurance, undiagnosed conditions in this population may be common. The authors call for advocacy focused on expansion of health insurance coverage, as lack of health insurance is strongly associated with poor access to care.

3. Emergency Room Rapid HIV Test Yields Lower-Than-Expected Specificity, Study Says

In 2006, the Centers for Disease Control and Prevention (CDC) recommended that all persons aged 13 to 64 be offered HIV screening in healthcare settings. Rapid HIV tests provide results before a patient leaves the healthcare setting and hold great appeal for screening in settings such as emergency departments. However, information is lacking about how often patients who have a positive rapid test in the emergency department actually have HIV infection confirmed with traditional HIV testing. In the study, 849 adults underwent HIV testing with the rapid test when they visited an emergency department for another reason. Of these, 39 tested positive. However, only 5 of the 39 were shown to actually have HIV infection after traditional testing was done. Twenty-six of 39 were negative and 8 refused traditional testing. This study suggests that many patients who test positive with this rapid HIV test are “false positives,” meaning that they do not truly have HIV infection. The authors conclude that quick and more reliable methods of testing are needed.

4. Combination of Behavior and Drug Therapies for Urge Incontinence Has Beneficial Impact on Patient Satisfaction

While urge incontinence, or “overactive bladder,” is commonly treated with pharmacotherapy and behavior modification, most patients do not achieve complete continence with either therapy alone. In a trial, 307 women with urge incontinence were randomly assigned to 10 weeks drug therapy plus behavioral training or drug therapy alone. Six months later, 41 percent of women in both groups reported a 70 percent or greater reduction in the frequency of incontinence episodes without additional treatment. However, more women in the combination therapy group reported that they were completely satisfied with their progress than did women in the drug therapy-alone group. According to the authors, the study results suggest that patient satisfaction may be influenced by other features such as volume of urine loss, frequency of voiding, or intensity of the urge sensation.

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