News From The Annals Of Internal Medicine: April 23, 2013
The U.S. Preventive Services Task Force reviews evidence for upcoming recommendations on suicide screening and treatment for adults and adolescents
An evidence review finds that there are screening tools to help physicians identify adults at risk for suicide, but there's no evidence that using these screening tools in primary care will actually prevent suicides in adults. There are still no proven primary care-relevant screening tools to identify suicide risk in adolescents. Suicide is the 10th leading cause of death in the U.S. Studies show that 38 percent of adults and 90 percent of youths had visited their primary care physicians in the 12 months prior to committing suicide. Finding accurate and feasible screening tools that can be used in the primary care setting could help to identify those at increased risk for suicide so that appropriate preventive measures can be taken. In 2004, the U.S. Preventive Services Task Force (USPSTF) concluded that evidence was insufficient to recommend for or against routine screening by primary care clinicians to detect suicide risk in the general population. To update its previous recommendation, the Task Force reviewed 56 studies published between January 2002 and July 2012. Although evidence was limited, the researchers found that primary care-feasible screening tools could probably identify adults at increased risk for suicide who need treatment. However, screening tools have limited ability to detect suicide risk in adolescents. Treatment with psychotherapy reduced the risk for suicide attempts by 32 percent in high-risk adults (e.g., those with a recent suicide attempt), but did not appear to benefit adolescents. No drug treatments were proven effective at reducing suicide risk in adults or adolescents. Draft recommendation statement based on this evidence review is available.*
2. Coronary Revascularization Surgery: Individualizing Treatment May be Key to Patient Survival
Comparative effectiveness study shows how patient characteristics affect outcomes in coronary artery bypass graft surgery versus percutaneous coronary intervention
Which coronary revascularization surgery provides the most mortality benefit may depend on individual patient characteristics. Researchers studied Medicare records for 105,156 patients undergoing multivessel coronary artery bypass graft (CABG) surgery or percutaneous coronary intervention (PCI) for coronary revascularization to assess whether patient clinical characteristics modify the comparative effectiveness of the procedures. The researchers found that CABG was far more likely than PCI to reduce mortality for the average patient with multivessel coronary disease. However, the researchers found that several patient characteristics significantly modified the comparative effectiveness of the two procedures. Patients with a history of peripheral arterial disease, tobacco use, diabetes, or heart failure fared better with CABG. Patients with none of those characteristics had better survival with PCI. According to the study authors, these findings underscore the need to personalize treatment recommendations for coronary revascularization among patients with multivessel coronary disease.