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25 February 2014 Annals of Internal Medicine Tip Sheet

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.

1. U.S. Preventive Services Task Force publishes final recommendation statement on multivitamins to prevent cardiovascular disease and cancer

The United States Preventive Services Task Force (USPSTF) recommends against the use of beta-carotene or vitamin E supplements for the primary prevention of cardiovascular disease or cancer, according to a recommendation statement being published in Annals of Internal Medicine. Researchers conducted a systematic review of the evidence to assess the benefits and harms of using vitamin, mineral, and multivitamin supplements for the primary prevention of cardiovascular disease and cancer. The evidence suggests that beta-carotene increases risk for lung cancer in people at risk for the disease. New evidence on the use of vitamin E proves that it lacks effectiveness in preventing cardiovascular disease or cancer. Evidence was insufficient to assess the benefits and harms of the use of multivitamins or single- or paired-nutrient supplements (with the exception of beta-carotene and vitamin E) for preventing cardiovascular disease and cancer. About half of U.S. adults report using at least one dietary supplement and about one-third report using a multivitamin-multimineral supplement. Appropriate intake of vitamin and mineral nutrients is essential to overall health. The benefits of vitamin supplementation are uncertain, so it is recommended that Americans get most of their nutrients from foods. Eating a nutrient-rich diet comprised of mostly fruits, vegetables, whole grains, fat-free and low-fat dairy products, and seafood should provide adequate nutrition. However, there may be specific groups of patients with well-defined conditions for whom specific nutrients will provide benefits. The focus of the recommendation is healthy adults without special nutritional needs. This is an update to the USPSTF’s 2003 recommendation.

2. Patient-Centered Outcomes Research Institute sets prioritized research agenda for managing two diverse conditions

Two articles being published in Annals of Internal Medicine seek to set prioritized research agendas to fill the evidence gaps about two diverse conditions – bipolar disorder in young people (http://www.annals.org/article.aspx?doi=10.7326/M13-2549) and ductal carcinoma in situ (DCIS) in women (http://www.annals.org/article.aspx?doi=10.7326/M13-2548). Both conditions present similar challenges to physicians and patients because the diagnosis is often not clear-cut and typical treatments come with a trade-off of benefits and serious side effects. Using a process described by the Patient-Centered Outcomes Research Institute (PCORI), researchers collaborated with various stakeholders including clinical experts, patients, and advocates to identify and rank the important gaps in knowledge that should be the focus of new research. In bipolar disorder, the researchers noted that the condition can be difficult to distinguish from other behavioral disorders among young people. Despite clinical uncertainty, the use of antipsychotic drugs in this population has increased significantly over the past 20 years. Antipsychotics carry a high risk for adverse effects. Looking at the available evidence, researchers identified 23 potential research needs in three areas: the comparative effectiveness of intervention strategies, the effect of antipsychotics on patient-centered outcomes, and the influence of various patient characteristics on the effectiveness of antipsychotics. In DCIS, there is considerable uncertainty about the optimal clinical management of the condition because of the lack of reliable methods for distinguishing DCIS that would never become symptomatic from DCIS that is likely to progress to life-threatening invasive cancer. The researchers identified knowledge gaps that should be addressed by future research, such as the incorporation of patient-centered outcomes, development of better methods to predict risk of invasive cancer, evaluation of a strategy of active surveillance, and testing of decision-making tools.