Chest
-
Randomized controlled trials (RCTs) are considered the highest level of evidence to establish causal associations in clinical research. There are many RCT designs and features that can be selected to address a research hypothesis. Designs of RCTs have become increasingly diverse as new methods have been proposed to evaluate increasingly complex scientific hypotheses. ⋯ To illustrate their diversity, examples of RCTs from the literature are provided. Statistical considerations, such as power and type I error rates, are discussed with the intention of providing practical guidance about how to specify study hypotheses that address the scientific question while being statistically appropriate. Finally, the freely available Consolidated Standards of Reporting Trials guidelines and US Food and Drug Administration guidance documents are introduced, along with a set of guidelines one should consider when planning an RCT or reviewing RCTs submitted for publication in peer-reviewed academic journals.
-
Economic evaluations, including cost-effectiveness analyses, are frameworks for decision-making. They help to illustrate tradeoffs between selecting one choice over another. This form of analysis is of great power and value to the health-care system. ⋯ This article provides an overview of the types of economic evaluations and their role in decision-making. It also discusses key study design considerations, including methods, scope, results, and reporting. Links to published checklists are provided along with additional sources of information, including a glossary of terms (Appendix), to guide the researcher to produce high-quality economic evaluations and guide the reviewer to provide high-quality feedback during the review process.
-
Guidelines for clinical documentation of evaluation and management face-to-face services were developed > 20 years ago. Recently, the Centers for Medicare & Medicaid Services (CMS) have addressed office and other outpatient services and the corresponding reimbursement, intending to reduce the amount of required documentation and to alleviate clerical burden. A CMS final rule for 2021 will eliminate the history and physical examination as criteria for level of service, allow time or medical decision-making to be used as coding criteria, and will recognize a code for prolonged service. The net effect of these changes may be some decrease in documentation burden, a change in the composition of clinical notes, and greater recognition by CMS of primary care and those who see highly complex patients requiring prolonged services.
-
Despite the wide-ranging benefits of pulmonary rehabilitation, conflicting results remain regarding whether people with COPD can improve their peak oxygen uptake (V˙O2peak) with aerobic training. ⋯ PROSPERO; No.: CRD42018099300; URL: https://www.crd.york.ac.uk/prospero/.
-
Multicenter Study
Differences in clinical characteristics and outcomes between men and women with idiopathic pulmonary fibrosis: a multicenter retrospective cohort study.
Idiopathic pulmonary fibrosis (IPF) is a disease with a male predominance. Prior data suggest that male sex is associated with disease progression and survival. The basis for this sex difference is unknown. ⋯ Male sex is associated with worse transplant-free survival in IPF. Cough may be a sex-specific predictor of survival in this population.