<i>Annals</i> Clinical Decision Making: Weighing Evidence to Inform Clinical Decisions
Authors: Joshua P. Metlay, Katrina A. Armstrong
Journal: Annals of Internal Medicine (2020)

Special Articles5 May 2020Annals Clinical Decision Making: Weighing Evidence to Inform Clinical DecisionsJoshua P. Metlay, MD, PhD and Katrina A. Armstrong, MD, MSJoshua P. Metlay, MD, PhDMassachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (J.P.M., K.A.A.) and Katrina A. Armstrong, MD, MSMassachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (J.P.M., K.A.A.)Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M19-1941 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Clinical decisions are ideally based on weighing the best available evidence on the risks and benefits of each option available, tailored to the individual patient in front of us. In many cases, evidence-based practice is well established, and a specific approach is supported consistently across guidelines from professional societies and print and online information sources. We can refer to these situations as "standards of care." But, in some cases, professional guidelines and print and online sources may disagree on the appropriateness and value of different strategies. Moreover, even in areas with broad consensus, new information that challenges the status quo, ...References1. Siemieniuk RA, Meade MO, Alonso-Coello P, et al. Corticosteroid therapy for patients hospitalized with community-acquired pneumonia: a systematic review and meta-analysis. Ann Intern Med. 2015;163:519-28. [PMID: 26258555]. doi:10.7326/M15-0715 LinkGoogle Scholar2. Metlay JP, Waterer GW, Long AC, et al. Diagnosis and treatment of adults with community-acquired pneumonia. An official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America. 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Randomized, controlled trials, observational studies, and the hierarchy of research designs. N Engl J Med. 2000;342:1887-92. [PMID: 10861325] CrossrefMedlineGoogle Scholar12. Armstrong KA, Metlay JP. Annals clinical decision making: translating population evidence to individual patients. Ann Intern Med. 2020;172:610-6. doi:10.7326/M19-3496 LinkGoogle Scholar13. Metlay JP, Armstrong KA. Annals clinical decision making: incorporating perspective into clinical decisions. Ann Intern Med. 21 April 2020. [Epub ahead of print]. doi:10.7326/M19-3469 LinkGoogle Scholar14. Waterer G. Systemic corticosteroids and community-acquired pneumonia—cautious optimism or wishful thinking? J Thorac Dis. 2015;7:E622-4. [PMID: 26793375] doi:10.3978/j.issn.2072-1439.2015.12.22 CrossrefMedlineGoogle Scholar15. Rodrigo C, Leonardi-Bee J, Nguyen-Van-Tam J, et al. Corticosteroids as adjunctive therapy in the treatment of influenza. Cochrane Database Syst Rev. 2016;3:CD010406. [PMID: 26950335] doi:10.1002/14651858.CD010406.pub2 CrossrefMedlineGoogle Scholar16. Torres A, Sibila O, Ferrer M, et al. Effect of corticosteroids on treatment failure among hospitalized patients with severe community-acquired pneumonia and high inflammatory response: a randomized clinical trial. JAMA. 2015;313:677-86. [PMID: 25688779] doi:10.1001/jama.2015.88 CrossrefMedlineGoogle Scholar17. Brown SM, Jones BE, Jephson AR, et al; Infectious Disease Society of America/American Thoracic Society 2007. Validation of the Infectious Disease Society of America/American Thoracic Society 2007 guidelines for severe community-acquired pneumonia. Crit Care Med. 2009;37:3010-6. [PMID: 19789456] doi:10.1097/CCM.0b013e3181b030d9 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (J.P.M., K.A.A.)Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M19-1941.Corresponding Author: Joshua P. Metlay, MD, PhD, Division of General Internal Medicine, Massachusetts General Hospital, 100 Cambridge Street, 16th Floor, Boston, MA 02114; e-mail, [email protected]harvard.edu.Current Author Addresses: Dr. Metlay: Division of General Internal Medicine, Massachusetts General Hospital, 100 Cambridge Street, 16th Floor, Boston, MA 02114.Dr. Armstrong: Massachusetts General Hospital, Gray-Bigelow 7, 55 Fruit Street, Boston, MA 02114.Author Contributions: Conception and design: J.P. Metlay, K.A. Armstrong.Analysis and interpretation of the data: J.P. Metlay.Drafting of the article: J.P. Metlay.Critical revision of the article for important intellectual content: J.P. Metlay, K.A. Armstrong.Final approval of the article: J.P. Metlay, K.A. Armstrong.Administrative, technical, or logistic support: J.P. Metlay, K.A. Armstrong.Collection and assembly of data: J.P. Metlay.This article was published at Annals.org on 21 April 2020. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoClinical Decision Making: Nurturing Our Core Skills Darren B. Taichman , Sankey V. Williams , and Christine Laine Annals Clinical Decision Making: Communicating Risk and Engaging Patients in Shared Decision Making Katrina A. Armstrong and Joshua P. Metlay Metrics Cited byNurse Managers' Involvement in Decision-Making and Associated Factors in Selected Government Hospitals, Addis Ababa, Ethiopia: A Cross-Sectional StudyThe future of research in hematology: Integration of conventional studies with real-world data and artificial intelligenceAssessing the Utility of In-Line Intravenous Infusion FiltersShared Decision MakingClinical Decision Making During the COVID-19 PandemicJoshua P. Metlay, MD, PhD and Katrina A. Armstrong, MD, MSCEConquest of COVID‐19. 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