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News From The Annals Of Internal Medicine: June 4, 2013

1. Daily Sunscreen Use Slows – Even in Middle-Age

For the first time, science proves that daily sunscreen use significantly slows skin aging, even in middle-aged men and women. Sunscreen and antioxidants have long been advocated to prevent skin aging, but to date, there has been no scientific evidence of their effectiveness. Researchers measured photoaging of 903 participants younger than 55 to determine whether regular use of sunscreen would slow skin aging compared with discretionary application. At the same time, researchers tested the anti-aging effects of beta-carotene supplements compared to placebo. Study participants were randomly assigned to one of four groups: daily use of broad-spectrum sunscreen and 30 mg of beta-carotene supplementation; daily use of sunscreen and placebo; discretionary use of sunscreen and 30 mg of beta-carotene supplementation; and discretionary use of sunscreen and placebo. After four years, participants in the daily sunscreen group showed 24 percent less skin aging than those in the discretionary group. The skin-saving effect of sunscreen was observed in all daily-use participants, regardless of age. No difference in skin aging was shown with daily beta-carotene supplementation compared with placebo.

2. Survey Shows Physicians Not Meeting CMS Objectives for Utilizing Electronic Health Records

Since 2009, the Centers for Medicare & Medicaid Services (CMS) have spent billions of dollars in the form of incentive payments to providers to encourage the adoption and meaningful use of electronic health records (). To qualify for payment, physicians must meet specific criteria as they move through stages of adoption. Ultimately, should allow physicians to provide high-quality, efficient, patient-centered care by using the data in their to measure and assess the care they provide to their . Little is known about the proportion of physicians who are able to meet meaningful use criteria or their use of EHRs to manage . Researchers surveyed 1,820 primary care physicians and specialists in office-based practices to evaluate physicians’ reports of adoption and ease of use and their ability to use EHRs to manage patient populations. The survey revealed that about 43 percent of physician respondents had a basic and about 10 percent met meaningful use criteria. Computerized systems for patient population management and quality reporting were not widespread, and physicians reported finding them difficult to use. The authors conclude that adopting does not ensure better management of patient populations.

3. Aspirin as Good as Dalteparin for Preventing Venous Thromboembolism After Hip Replacement

Extended use of aspirin may be an effective, safe, convenient, and inexpensive alternative to low-molecular-weight heparin for preventing venous thromboembolism (VTE), a common complication after total hip replacement. Using low-molecular-weight heparin for 30 days after hip replacement has been shown to reduce the rate of VTE, but it is expensive and is associated with bleeding after surgery. Researchers sought to determine if using aspirin after initial treatment with low-molecular-weight heparin would be an effective alternative to extension of low-molecular-weight heparin. After an initial 10 days of dalteparin prophylaxis following elective hip replacement, 778 patients were randomly assigned to 28 days of dalteparin (n=400) or aspirin (n=386). After 28 days, five patients in the dalteparin group and one patient in the aspirin group had a VTE event, suggesting that aspirin is noninferior, but not superior to dalteparin for the prevention of VTE. The data also suggest that aspirin may cause less bleeding than dalteparin.

4. Blood Tests May be Accurate for Diagnosing Liver Disease in Hep C Patients

Available blood tests are accurate compared to liver biopsy for diagnosing fibrosis and cirrhosis in patients with hepatitis C virus (HCV) infection. HCV-related liver disease is the most common reason for liver transplantation among American adults and is a leading cause of liver cancer. Liver biopsy is the standard for assessing the histologic stage of HCV and has been recommended before antiviral therapy to target treatment to patients at higher risk for disease progression. The drawbacks of liver biopsy include the potential for sampling error, variability in interpretation, and risk for complications such as bleeding, severe pain, and infection. Researchers reviewed 172 published studies to evaluate the diagnostic accuracy of blood tests versus liver biopsy for diagnosing fibrosis or cirrhosis in patients with HCV. They found that blood tests can help to identify HCV patients clinically significant fibrosis. Blood tests had somewhat greater accuracy for diagnosing cirrhosis than for less advanced fibrosis.


American College of Physicians