Diagnostic testing is an essential tool in clinical decision making. This article in the Annals Clinical Decision Making series reviews core principles underlying the approach to choosing and interpreting diagnostic tests for individual patients.
One of the most painful aspects of this pandemic is the irremediable separation of patients from their families at the end of their lives.
Background:A novel human coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was identified in China in December 2019. There is limited support for many of its key epidemiologic features, including the incubation period for clinical disease (coronavirus disease 2019 [COVID-19]), which has important implications for surveillance and control activities.Objective:To estimate the length of the incubation period of COVID-19 and describe its public health implications.Design:Pooled...
The Parkinson Study Group STEADY-PD III Investigators reported the results of a randomized controlled trial evaluating the effect of isradipine, a dihydropyridine calcium-channel blocker, on clinical progression of Parkinson disease. The editorialists discuss the findings and the need for more reliable in vivo biomarkers of Parkinson disease progression and measures of specific target engagement.
State-based medical license applications often ask about mental health diagnoses and treatment in terms that stigmatize mental illness, which inadvertently discourages physicians from seeking care. In this article, the authors describe a recent collaboration that resulted in updated and destigmatized language on their state's medical license application.
Estimates suggest that COVID-19 will stress bed capacity, equipment, and health care personnel in U.S. hospitals in ways not previously experienced. How can health systems prepare to care for a large influx of patients with this disease?
This paper in the Annals Clinical Decision Making series explains a practical approach to evaluating whether the conclusions of studies involving many patients or whole populations may be confidently applied to the care of an individual patient.
Walensky and colleagues' cost-effectiveness analysis estimated the potential clinical benefits of tenofovir alafenamide–emtricitabine (F/TAF) and the resultant cost savings of lower risk for renal failure and fractures versus the increased cost of branded F/TAF compared with generic tenofovir disoproxil fumarate–emtricitabine for HIV preexposure prophylaxis (PrEP). The editorialists believe that the findings make it clear that shifting to F/TAF as first-line PrEP for all should not be universally...
Making diagnostic and management decisions is the core skill of physicians. The editors introduce the Annals Clinical Decision Making series, a collection of coordinated articles designed to help all physicians hone their skills.
Background:Tenofovir alafenamide–emtricitabine (F/TAF) was recently approved as a noninferior and potentially safer option than tenofovir disoproxil fumarate–emtricitabine (F/TDF) for HIV preexposure prophylaxis (PrEP) in the United States.Objective:To estimate the greatest possible clinical benefits and economic savings attributable to the improved safety profile of F/TAF and the maximum price payers should be willing to pay for F/TAF over generic F/TDF.Design:Cost-effectiveness analysis.Data Sources:Published...
Deciding when recently published evidence should alter practice can be daunting. This article in the Annals Clinical Decision Making series discusses the care of a patient with a common problem and recently published studies to illustrate an approach to weighing new evidence not yet considered by practice guidelines that conflicts with existing recommendations.
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