Annals
Established in 1927 by the American College of Physicians

FOR THE PRESS

14 August 2012 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 215-351-2653 or e-mail Angela Collom at acollom@acponline.org

1. Task Force Finds Insufficient Evidence to Weigh the Benefits and Harms of Routine Screening for Age-related Hearing Loss

Age-related hearing loss is a common health problem that can affect independence, emotional well-being, and quality of life. Several screening methods have proven accurate for identifying hearing impairment, including simple clinical tools and questionnaires. In 1996, the United States Preventive Services Task Force recommended that primary care physicians periodically question older adults about their hearing, counsel them about hearing aids, and make referrals when appropriate. This recommendation was based on available evidence, and focused on patients with established or perceived hearing loss. To update its 1996 recommendations, the Task Force reviewed articles published between 1950 and January 2010 on screening for age-related hearing impairment in adults 50 and older who had not been previously diagnosed with hearing loss in the primary care setting. The Task Force considered evidence on the association of screening with improved health outcomes; the accuracy of screening methods; the incremental benefits of early detection; the effectiveness of treatment; and the harms of screening and treatment. While few studies showed that screening resulted in increased hearing aid use, no studies examined whether it improved emotional and social functioning, communication ability, and cognitive function. Since screening and confirmatory testing for hearing impairment are noninvasive and serious harms of treatment are rare, the Task Force can conclude that there are likely little to no adverse effects of screening for hearing loss. However, no trials evaluate for adverse events. With many existing research gaps, the Task Force cannot recommend for or against screening for age-related hearing loss in the primary care setting.

2. Little Evidence to Suggest Second-generation Antipsychotics Are More Effective for Schizophrenia Than First-generation Drugs

Second-generation antipsychotics (SGAs) for treating schizophrenia were developed to address the safety and efficacy issues associated with first-generation antipsychotics (FGAs). Today, three-quarters of adult patients prescribed antipsychotic medications take SGAs, accounting for 93 percent of the $2.8 billion spent each year on these medications. But recent published articles have questioned whether there are clinically important differences in patient outcomes between FGAs and SGAs. Researchers at the Agency for Healthcare Research and Quality (AHRQ) reviewed 114 studies involving 22 comparisons of FGAs and SGAs. The researchers assessed differences in symptoms, adverse events such as diabetes, mortality, tardive dyskinesia (neurological disorder that causes involuntary, repetitive movements, a common side effect of long-term antipsychotic use), and major metabolic syndrome in patients aged 18-24 with schizophrenia and related psychosis. The researchers found little research to support the use of SGAs for treating positive symptoms. They found moderate evidence that the SGAs olanzapine and risperidone treated negative symptoms more effectively than the FGA haloperidol based on the Scale for the Assessment of Negative Symptoms (SANS). There was insufficient evidence to compare adverse events. The researchers recommend more focused studies on drug safety. They conclude that the current evidence is inadequate to inform clinical decisions.