Public Release: 

May/June 2004 Annals of Family Medicine tip sheet

American Academy of Family Physicians

U.S. Preventive Services Task Force Recommends Against Routine Ovarian Cancer Screening
Asserting that the potential harms outweigh the potential benefits, the U.S. Preventive Services Task Force recommends against routine screening for ovarian cancer. The new recommendation statement reflects no change from its 1996 recommendation against routine ovarian cancer screening. The Task Force found no existing evidence that any screening test, including screening with serum CA-125, ultrasound or pelvic examination, reduces mortality from ovarian cancer. Other clinical considerations cited by the Task Force include the low prevalence of ovarian cancer and the invasive nature of diagnostic testing after a positive screening. Ovarian cancer is the fifth leading cause of cancer death among women in the United States, accounting for an estimated 25,400 cases and 14,300 deaths in 2003.

U.S. Preventive Services Task Force Recommends that Primary Care Physicians Screen Children for Common Causes of Visual Impairment According to a new U.S. Preventive Services Task Force recommendation, children under the age of 5 should be screened for the most common causes of visual impairment, including amblyopia, strabismus and visual acuity. The Task Force found that early detection and treatment of amblyopia and amblyogenic risk factors can improve visual acuity. Left uncorrected, amblyopia may harm school performance, ability to learn, self image, and may be a risk factor for future total blindness. Visual impairment caused by refractive error, amblyopia, strabismus and astigmatism is a common condition among young children, affecting five to 10 percent of all preschoolers.

Study Shows Patient Misunderstanding and Misuse of Common Over-the-Counter Medication for Urinary Tract Infections
In a survey of 434 customers at 31 Los Angeles County pharmacies, Shi, et al, found that many consumers have a poor understanding of the cause of their symptoms and the purpose of the widely-marketed over-the-counter drug phenazopyridine, a urinary analgesic for the treatment of pain associated with urinary tract infections. Although respondents had access to the package label at the time of the survey, only 57 percent knew phenazopyridine was a urinary tract analgesic. All other respondents believed the drug had other actions, such as antibacterial or curative effects. This misconception, the authors assert, can potentially lead to under-treatment of urinary tract infections and other urinary conditions. Additionally, only 29 percent of those surveyed believed their symptoms were due to a urinary tract infection or bladder infection. Poor consumer knowledge was associated with non-white race, first-time use of the drug and less contact with health providers. The authors conclude that though package labels contain important drug information, a more active method of communication is necessary to get self-care information to consumers. As popular prescription drugs like proton pump inhibitors and statins head toward the OTC marketplace, they add, better patient education and post-marketing surveillance are essential to assure proper usage of over-the-counter medications.

A Single Blood Pressure Reading Found to be an Accurate Predictor of Future Cardiovascular Problems
Analyzing the electronic health records of 5,825 patients, Tierney, et al, found that a single measurement of pulse and blood pressure, recorded as part of ongoing primary care, conveys important information about the five-year risk for stroke, heart and kidney disease, and death. The most consistent vital sign found to predict adverse clinical events was systolic blood pressure. Specifically, the researchers found that an elevation of 10 mmHg in blood pressure was associated with an increase in risk ranging from 6 percent for stroke or myocardial infarction to 13 percent for chronic renal insufficiency. The authors point out that too often in practice, physicians ignore a single elevated blood pressure reading, opting to wait and reassess the patient during the next visit. They suggest that blood pressure and heart rate are truly vital signs and elevations should be taken seriously and treated. OTHER STUDIES IN THIS ISSUE:

Referral of Patients to Specialists: Factors Affecting Choice of Specialist by Primary Care Physicians
By Neil R. Powe, M.D., M.P.H., M.B.A., et al
Primary care physicians serving adults consider several factors to be of major importance when choosing a specialist for patient referral. The importance of patient convenience, previous experience with the specialist, specialist board certification and insurance coverage accepted by specialist varies with the race and sex of the referring physician.

What Can Family Physicians Offer Patients with Carpal Tunnel Syndrome Other than Surgery? A Systematic Review of Nonsurgical Management
By Felicity Goodyear-Smith, M.B., Ch.B., M.G.P., et al
A systematic review of the literature on treatments for carpal tunnel syndrome found good evidence to support some nonsurgical treatments. There is strong evidence that local corticosteroid injections, and to a lesser extent oral corticosteroids, give short-term relief for patients. There is weaker but still useful evidence for other treatments, including splinting, laser-acupuncture, yoga and therapeutic ultrasound.

Patient Pain in Primary Care: Factors That Influence Physician Diagnosis
By Klea D. Bertakis, M.D., M.P.H., et al
This study goes beyond many studies showing low rates of recognition of pain by clinicians and identifies factors associated with pain recognition. The authors found that the diagnosis of pain is strongly influenced by the severity of the pain reported by the patient, patient sex and physician practice style.

Medical Management of Intimate Partner Violence Considering the Stages of Change: Precontemplation and Contemplation
By Therese Zink, M.D., M.P.H.
In a qualitative study, researchers found that women who are the victims of intimate partner violence exhibit different stages of readiness to change that can be used to tailor screening and intervention by clinicians. Stage-matched interventions might make office visits more efficient and increase physician and patient satisfaction.

Accuracy of Screening for Diabetic Retinopathy by Family Physicians
By James M. Gill, M.D., M.P.H., et al
Using standardized criteria and the PanOptic ophthalmoscope, a new technology for screening for diabetic retinopathy, family physicians were fairly accurate in screening patients for diabetic retinopathy. Whereas this technique is not sufficiently accurate to replace routine referral to an ophthalmologist for all patients with diabetes, it can be used to improve care for those patients who fail to get routine eye screenings.

A Randomized Clinical Trial of the Effect of Intraoperative Saline Perfusion on Post-Vasectomy Azoospermia
By Timothy G. Schuster, et al
Flushing the prostatic end of the vas deferens during vasectomy has been hypothesized to shorten the time needed to reach azoospermia, or the complete absence of sperm in the ejaculate. However, in this randomized clinical trail, a saline flush did not decrease the time required to achieve azoospermia.

What Complementary and Alternative Medicine Practitioners Say About Health and Health Care
By Bruce Barrett, M.D., Ph.D., et al
In-depth interviews with 32 practitioners of complementary and alternative medicine (CAM) revealed that in general, CAM practitioners want to work with physicians and other conventional health care providers. They argue for holistic, empowering and accessible health care and voice the need for an integrated health care system. What is an Intracluster Correlation Coefficient? Crucial Concepts for Primary Care Researchers
By Shersten Killip, M.D., M.P.H., et al
Primary care researchers, who frequently use clustered designs, must recognize and understand the implications of clusters to avoid costly sample size errors. Using a case study with accompanying equations, the authors show that clustered samples are not as statistically efficient as simple random samples.

Adjusted X2 Statistics: Application to Clustered Binary Data in Primary Care
By James F. Reed III, Ph.D.
Randomized cluster trials are an important and increasingly popular experimental design but serious design and analysis implications abound. This article provides an introduction to the problems of analyzing binary data from clustered data in clinical research.


Annals of Family Medicine is a peer-reviewed research journal that provides a cross-disciplinary forum for new, evidence-based information affecting the primary care discipline. Launched in May 2003, the journal is sponsored by six family medical organizations, including the American Academy of Family Physicians, the American Board of Family Practice, the Society of Teachers of Family Medicine, the Association of Departments of Family Medicine, the Association of Family Practice Residency Directors and the North American Primary Care Research Group. The journal is published six times each year and contains original research from the clinical, biomedical, social and health services areas, as well as contributions on methodology and theory, selected reviews, essays and editorials. A board of directors with representatives from each of the sponsoring organizations oversees Annals. Complete editorial content and interactive discussion groups can be accessed free of charge on the journal's Web site,

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