27.2.07

Systematic review: the value of the periodic health evaluation.

Ann Intern Med. 2007 Feb 20;146(4):289-300.
Boulware LE, Marinopoulos S, Phillips KA, Hwang CW, Maynor K, Merenstein D,Wilson RF, Barnes GJ, Bass EB, Powe NR, Daumit GL.Welch
Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins School of Medicine, and Johns Hopkins Bloomberg School of Public Health,Baltimore, Maryland, USA. lboulwa@jhmi.edu
BACKGROUND: The periodic health evaluation (PHE) has been a fundamental part ofmedical practice for decades despite a lack of consensus on its value.
PURPOSE:To synthesize the evidence on benefits and harms of the PHE.
DATA SOURCES:Electronic searches of such databases as MEDLINE and the Cochrane Library,review of reference lists, and hand- searching of journals through September2006. STUDY SELECTION: Studies (English-language only) assessing the delivery ofpreventive services, clinical outcomes, and costs among patients receiving thePHE versus those receiving usual care.
DATA EXTRACTION: Study design andsettings, descriptions of the PHE, and clinical outcomes associated with thePHE.
DATA SYNTHESIS: The best available evidence assessing benefits or harms ofthe PHE consisted of 21 studies published from 1973 to 2004. The PHE had aconsistently beneficial association with patient receipt of gynecologicexaminations and Papanicolaou smears, cholesterol screening, and fecal occultblood testing. The PHE also had a beneficial effect on patient "worry" in 1randomized, controlled trial but had mixed effects on other clinical outcomesand costs.
LIMITATIONS: Descriptions of the PHE and outcomes were heterogeneous.Some trials were performed before U.S. Preventive Services Task Force guidelineswere disseminated, limiting their applicability to modern practice.
CONCLUSIONS: Evidence suggests that the PHE improves delivery of some recommended preventiveservices and may lessen patient worry. Although additional research is needed toclarify the long-term benefits, harms, and costs of receiving the PHE, evidenceof benefits in this study justifies implementation of the PHE in clinicalpractice.

17.2.07

American Cancer Society Guideline for Human Papillomavirus (HPV) Vaccine Use to Prevent Cervical Cancer and Its Precursors.

Saslow D, Castle PE, Cox JT, Davey DD, Einstein MH, Ferris DG, Goldie SJ, HarperDM, Kinney W, Moscicki AB, Noller KL, Wheeler CM, Ades T, Andrews KS, DoroshenkMK, Kahn KG, Schmidt C, Shafey O, Smith RA, Partridge EE, Garcia F.
University of Arizona National Center of Excellence in Women's Health and theArizona Hispanic Center of Excellence, Tucson, AZ.
The American Cancer Society (ACS) has developed guidelines for the use of the prophylactic human papillomavirus (HPV) vaccine for the prevention of cervical intraepithelial neoplasia and cervical cancer. These recommendations are basedon a formal review of the available evidence. They address the use of prophylactic HPV vaccines, including who should be vaccinated and at what age, as well as a summary of policy and implementation issues. Implications for screening are also discussed.

14.2.07

Amblyopia.

Doshi NR, Rodriguez MLF.
Am Fam Physician 2007; 75: 361-368.
Amblyopia, a decrease in visual acuity, is a major public health problem with a prevalence of 1 to 4 percent in the United States. It is thought to develop early in life during the critical period of visual development. Early recognition of amblyogenic risk factors such as strabismus, refractive errors, and anatomic obstructions can facilitate early treatment and increase the chance for recovery of visual acuity. Multiple medical organizations endorse screening for visual abnormalities in children and young adults, yet only 20 percent of school-age children have routine vision screening examinations. Any child with a visual acuity in either eye of 20/40 or worse at age three to five years or 20/30 or worse at age six years or older, or a two-line difference in acuity between eyes, should be referred to an ophthalmologist for further evaluation and definitive therapy. Treatment is started at the time of diagnosis and depends on the etiology. Treatment options for children with strabismus include patching and atropine drops. Children with refractive errors should be prescribed corrective lenses. Corneal lesions, cataracts, and ptosis require surgery. The success of therapy is highly dependent on treatment compliance. Patients and their parents should be educated about the need for regular follow-up and the risk of permanent vision loss.