Vital Signs: Awareness: Top 5 Don’ts for Doctors in Primary Care

Antibiotics for sore throats and CT scans for minor head injuries in children are among the most wasteful practices in primary care medicine, a national physicians’ group said last week. Among the others are electrocardiograms performed routinely on healthy adults and widespread prescribing of brand-name statins to reduce L.D.L., or “bad” cholesterol.

The group issuing the report, the National Physicians Alliance, an organization of some 22,000 physicians, developed three separate “Top 5” lists for primary care doctors — internists, family doctors and pediatricians — that were essentially lists of medical “don’ts.” The lists were published online in The Archives of Internal Medicine.

The authors urged doctors not to perform bone-density scans on women younger than 65 and men younger than 70 who have no risk factors for osteoporosis. The researchers also urged physicians to forgo basic blood screening in healthy adults (though screening for cholesterol was recommended, as was diabetes screening in some cases).

“Doctors are inundated with ‘do this’ and ‘do that.’ We wanted to focus on what doctors should not do,” said Dr. Stephen Smith, professor emeritus of family medicine at the Warren Alpert Medical School at Brown University, who led the initiative. “We wanted to come up with the top things that primary care physicians can do that would enhance quality, but also reflect the idea of being good stewards of finite medical resources, save money and reduce harms and risks.”

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Vital Signs: Screening: Saliva Test for Cytomegalovirus Proves Accurate

 

A new test offers a rapid, inexpensive and highly accurate method for screening newborns for cytomegalovirus, which can cause permanent hearing loss, researchers said on Wednesday.

Though one in 150 babies are born infected with cytomegalovirus — known as CMV and part of the herpes virus family — current tests are not effective for widespread screening, the scientists said.

The new test does not require the culturing of blood samples; it employs saliva, easily obtained by swabbing the inside of a baby’s mouth.

Of 17,662 newborns screened, all 85 infants identified as infected with CMV by a blood culture test also were identified by the new test, researchers reported in a paper published in The New England Journal of Medicine. Another 17,327 newborns were screened with a different saliva test. It was slightly less accurate, detecting CMV in 74 of 76 infants identified by culturing.

Infected babies must be monitored and tested frequently for hearing loss so that support services can be provided if necessary, said Dr. Suresh B. Boppana, a professor of pediatrics at University of Alabama at Birmingham and one of the paper’s authors.

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Vital Signs: Patterns: More People Praying About Health, Analysis Finds

More Americans are praying about their health, researchers have concluded.

Scientists analyzed data on 30,080 adults ages 18 and older who took part in the National Health Interview Survey in 2002 and on 22,306 adults who participated in 2007.

Forty-nine percent of adults said in 2007 that they had prayed about their health during the previous year, up from 43 percent in 2002. In 1999, only 14 percent of survey participants said they had prayed about their health.

Among those least likely to pray were people who exercised on a regular basis; researchers speculated they may not have had any health concerns. Those with higher incomes were also less likely to pray.

According to the analysis, published in the May issue of the journal Psychology of Religion and Spirituality, the use of prayer has increased in recent years among adults of all ages. Women, black people, older and married individuals and those whose health status had changed — for better or worse — were more likely than others to pray. People with episodes of depression and dental pain also turned to prayer at high rates.

“We were surprised,” said Amy Wachholtz, director of health psychology at University of Massachusetts and co-author of the paper. “Our best guess is that it has to do with 9/11, but that’s an untested hypothesis. There doesn’t seem to be any other primary, overwhelming issue that would have so globally affected people.”

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Vital Signs: Screenings: When It’s Too Soon for a New Colonoscopy

While many uninsured patients cannot afford to undergo colonoscopy screening as often as they should, a new study suggests many older Medicare beneficiaries receive the colon cancer test too often.

In a sample of 24,000 Medicare beneficiaries 66 and older, almost half of those who had a normal colonoscopy between 2001 and 2003 underwent a repeat exam within seven years, instead of waiting the recommended 10 years, researchers reported in a study published online on May 9 in Archives of Internal Medicine.

Yet, 42 percent of those repeat patients had no symptoms indicating another screen had been necessary — meaning that almost one in four had a second colonoscopy for no apparent reason.

Although current guidelines recommend against routine screening after age 75, the researchers found that many patients in their late 70s and 80s with a normal test also repeated it within seven years.

With rare exceptions, the costs, nearly $1,000 per colonoscopy, were paid by Medicare.

Colonoscopies do pose some small risks, including perforation of the colon. “This screen is not benign,” said Dr. James S. Goodwin, the study’s lead author. “When you do it every 10 years, the benefit far outweighs any potential harm. But you get no added benefit by screening every five years, and you double the harm.”