Annals
Established in 1927 by the American College of Physicians

FOR THE PRESS

3 June 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. Task Force: Screen high-risk individuals for hepatitis B

The U.S. Preventive Services Task Force (USPSTF) recommends hepatitis B virus (HBV) screening for nonpregnant high-risk adolescents and adults, according to a recommendation statement being published in Annals of Internal Medicine (http://www.annals.org/article.aspx?doi=10.7326/M14-1018). Up to 2.2 million people in the United States have chronic HBV, and 15 to 25 percent of those infected will die from liver disease or liver cancer. Screening for HBV could identify those who may benefit from treatment. Most people born in the United States have been vaccinated for HBV, which is the most effective way to prevent infection. However, there are some characteristics that put people at high risk. Those at high risk for HBV infection include persons born in countries with a high prevalence of HBV infection; U.S. citizens not vaccinated in infancy and whose parents are from a high-risk country; HIV-positive persons; injection drug users; those who have household contact with someone infected with HBV; and men who have sex with men. Researchers conducted a systematic review of published evidence to assess the benefits and harms of screening high-risk individuals for HBV. They conclude with moderate certainty that screening for HBV infection in high-risk individuals has moderate net benefit. The recommendation applies to asymptomatic, nonpregnant adolescents and adults who have not been vaccinated and other persons at high risk. This is an update to a 2004 recommendation. Previously, the USPSTF focused its recommendation on only the general population. The authors of an accompanying editorial express strong support for the new recommendations, but suggest that the guidelines should provide a clearer definition of “high-risk” to help busy clinicians apply these recommendations more easily in practice.

2. Postnatal immunoprophylaxis effective for preventing maternal transmission of hepatitis B

Postnatal prophylaxis is highly effective in preventing maternal transmission of hepatitis B virus (HBV) infection, according to an article being published in Annals of Internal Medicine (http://www.annals.org/article.aspx?doi=10.7326/M13-2529). Approximately 24,000 HBV-infected women give birth annually in the United States, which makes their offspring an important at-risk population. The Centers for Disease Control and Prevention (CDC) recommends that pregnant women be screened for HBV and that infants of HBV-positive mothers receive immunoprophylaxis. Researchers studied health records for 4,446 infants born to 3,253 HBV-positive mothers between 1997 and 2010 to investigate the effectiveness of a contemporary immunoprophylaxis protocol administered in an integrated health services delivery organization. Adherence, follow-up testing, transmission rates, and maternal risk factors for transmission were evaluated. The researchers found that an organized program with high rates of prenatal screening, detection, and immunoprophylaxis with hepatitis B immunoglobin is effective at preventing perinatal transmission.

3. Some transitional care interventions more effective than others for reducing mortality, readmissions after heart failure

Home-visiting programs and multidisciplinary heart failure (MDS-HF) clinic interventions reduce all-cause mortality and hospital readmissions following heart failure, according to an article being published in Annals of Internal Medicine (http://www.annals.org/article.aspx?doi=10.7326/M14-0083). Structured telephone support (STS) reduced HF-specific mortality and readmission. HF is the leading cause of hospitalization and health care costs in the United States and up to 25 percent of patients hospitalized with HF are readmitted within 30 days. Researchers conducted a systematic review and meta-analysis of published research to assess the efficacy of various transitional care interventions intended to reduce readmission and mortality rates for adults hospitalized with HF. These included home-visiting programs, STS, telemonitoring (remote monitoring of vitals, etc.), outpatient clinic-based, primarily educational (self-care training delivered before discharge), and others that did not fit into a broader category, such as individual peer support. The researchers found that MDS-HF clinic interventions had the best evidence for reducing all-cause readmissions and mortality up to six months after hospitalization for HF. STS interventions proved effective for reducing HF-specific readmission and mortality.

4. Analysis shows cancer center ads heavy on emotion, light on information

Emotional reactions to cancer center consumer advertisements may lead to unrealistic expectations and inappropriate treatments, according to an article being published in Annals of Internal Medicine (http://www.annals.org/article.aspx?doi=10.7326/M14-0500). Demand for cancer care is increasing rapidly in the United States and a growing number of cancer centers are marketing their clinical services directly to patients through consumer advertising. Researchers conducted a rigorous content review of 409 unique television and magazine advertisements for 102 cancer centers to characterize their informational and emotional content. The researchers assessed each ad for types of clinical services promoted, information provided about those services, use of emotional appeals, and the use of patient testimonials and disclaimers. The analysis showed that the majority of cancer centers (88 percent) promoted cancer treatments rather than screening (18 percent) or supportive services (13 percent). Ads tended promote benefits of advertised therapies more often than risks, with no specific data offered to support claims. Eighty-five percent of advertisements used emotional appeals that seemed to equate treatment with cure, and more often focused a cure (85 percent) rather than comfort, quality of life, or patient-centered care (43 percent). Patient testimonials were featured in about half of cancer center ads and the majority of those (79 percent) focused on stories about survival or cure. The authors suggest that cancer center ads that evoke emotions of fear and hope may lead patients to pursue care that is either unnecessary or unsupported by scientific evidence.