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News from Annals of Internal Medicine Supplement Nov. 18 2014

1. Recommending MyFitnessPal to obese patients unlikely to produce

Using a smartphone app is unlikely to produce substantial weight loss for most overweight patients, according to an article being published in an electronic supplement to . Obesity has become an epidemic in the United States and rarely have the time or resources to discuss weight loss with obese patients. The ubiquitous smartphone could be a cost-effective tool for helping obese individuals change behaviors and improve health, but smartphone apps designed for weight loss have not been rigorously evaluated. Researchers randomly assigned 212 obese patients (BMI of 25 kg/m2 or greater) to either usual care alone or usual care plus assistance in downloading the free MyFitnessPal app to their smartphone. To use the MyFitnessPal app, users log in and record everything they eat or drink. The app keeps track of calories and nutritional values. After six months, weight loss was minimal in both the usual care and the intervention groups. The authors note that initially patients were enthusiastic about using the app, but quickly lost interest in recording their food. The authors suggest that future updates should focus on making the app more engaging and less time-consuming, which could increase adherence and improve outcomes.

2. A chance at $50 is enough to entice patients to follow through with colon cancer screening

A one in 10 chance of winning $50 was more effective than five other tested financial incentives for getting patients to complete a fecal occult blood test (FOBT) for colorectal cancer (CRC), according to a study being published in an electronic supplement to Annals of Internal Medicine. A fecal occult blood test (FOBT) is considered an inexpensive and convenient way for patients to screen for CRC compared to other screening methods. However, only about one-third of patients complete the FOBT, which requires patients to take a sample of their bowel movement and mail it to a lab. Researchers sought to determine if financial incentives could improve test compliance. In the first of two trial stages, 713 patients who were prescribed an FOBT were randomly assigned to either usual care or receipt of $5, $10, or $20 for completing the FOBT (completion occurs when the test is received by the lab). In the second stage, 836 different patients were randomly assigned to either usual care or receipt of $5, a one in 10 chance of winning $50, or entry into a $500 raffle for completing the FOBT. The lottery approach, or having a one in 10 chance of winning $50, increased the test completion rate by 20 percent. None of the other financial incentives tested was effective at getting patients to complete the FOBT.

3. Special physician training decreases antibiotic misuse, saves costs An education program aimed at teaching physicians self-stewardship with regard to antibiotic use reduces overall costs and targeted antibiotic prescribing, according to an article being published in an online supplement in Annals of Internal Medicine. The Centers for Disease Control and Prevention (CDC) suggest that nearly 50 percent of antibiotic use is unnecessary or inappropriate. The CDC’s ‘Get Smart for Healthcare’ campaign calls for physicians to take antibiotic ‘time-outs’ to review antibiotic dose, duration, and indication when cultures and new clinical information becomes available. Preventing antibiotic resistance and Clostridium difficile infection are the two main goals of antimicrobial stewardship. However, without education and a formal structure, the time-outs that serve as a key component of stewardship could be forgotten or underutilized. To optimize antibiotic use through trainee-led time-outs, researchers provided monthly in-person training for physicians and residents on appropriate antibiotic use and implemented a weekly review of all patients receiving antibiotics. This approach decreased inappropriate antibiotic use and resulted in a mild decline in Clostridium difficile infections.


1. Effectiveness of a Smartphone Application for Weight Loss Compared With Usual Care in Overweight Primary Care Patients: A Randomized, Controlled Trial . 2014;161(10_Supplement):S5-S12. doi:10.7326/M13-3005

2. Financial Incentives for Completion of Fecal Occult Blood Tests Among Veterans: A 2-Stage, Pragmatic, Cluster, Randomized, Controlled Trial Ann Intern Med. 2014;161(10_Supplement):S35-S43. doi:10.7326/M13-3015

3. Antibiotic Self-stewardship: Trainee-Led Structured Antibiotic Time-outs to Improve Antimicrobial Use Ann Intern Med. 2014;161(10_Supplement):S53-S58. doi:10.7326/M13-3016

American College of Physicians