Annals of Internal Medicine tip sheet for July 8, 2014

July 07, 2014

1. Task Force recommends against screening for carotid artery stenosis in general adult population

The United States Preventive Services Task Force recommends against screening for asymptomatic carotid artery stenosis in the general adult population, according to a recommendation statement being published in Annals of Internal Medicine. Stroke is a leading cause of death and disability in the United States and having carotid artery stenosis (a buildup of plaque in the carotid arteries that causes them to narrow) is a risk factor. although it accounts for a smaller number of strokes than the major risk factors hypertension, diabetes and hyperlipidemia. Ultrasonography is the most convenient and non-invasive screening test for carotid artery stenosis, but it is associated with a high rate of false positive results. Researchers conducted a systematic review of 56 published studies and found no evidence of a benefit for screening for carotid artery stenosis in the general population, but did find a small to moderate risk for harms, such as stroke, myocardial infarction, and mortality with the interventions that may follow positive screening results. The severity of harms depended on patient population, surgeon, center volume, and geographic location. This update reconfirms the Task Force's 2007 recommendation on screening for carotid artery stenosis. The authors of an accompanying editorial write that although the data clearly support the USPSTF recommendation against population screening, these types of screenings are still offered to the public at fairs and other settings. They suggest that physician specialty society initiatives (e.g. Choosing Wisely from the American Board of Internal Medicine and High Value Care from the American College of Physicians) strengthen their messaging so that potential consumers of these services are aware that the test is unlikely to prevent them from having a stroke or lead to improvements in their health.

Note: The URL will go live at 5:00 p.m. on Monday, July 7 and can be included in news stories. For an embargoed PDF, please contact Megan Hanks or Angela Collom. To speak with a member of the Task Force, please contact Ana Fullmer or Nicole Raisch at or 202-350-6668.

2. Young adults offer suggestions to improve

Researchers at the Perelman School of Medicine at the University of Pennsylvania interviewed a focus group of young adults to glean six suggestions for improving the website. The actionable improvements are discussed in an article being published in Annals of Internal Medicine. Thirty-three highly educated young adults aged 19 to 30 years in Philadelphia were asked about their impressions and their suggestions for improvements as they navigated the website during the first open enrollment period for the Affordable Care Act's health insurance marketplace. The young people offered six specific changes to improve the customer experience before the next enrollment period in November 2014. Among their suggestions, they asked for a glossary of terms; better descriptions of services that are included in their policies; and explanations of financial details and discounts. The young people also suggested that the term "catastrophic" be replaced with a less negative or confusing word that better conveys the meaning of what is covered by catastrophic insurance. According to the study authors, the young people's suggestions show how small changes to the website could improve consumers' understanding of a difficult process and also improve the usability of the website.

Note: The URL will go live at 5:00 p.m. on Monday, July 7 and can be included in news stories. For an embargoed PDF, please contact Megan Hanks or Angela Collom. To speak with the author, please contact Katie Delach at or 215-349-5964.

American College of Physicians

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