Aust Prescr
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The novel coronavirus SARS-CoV-2, the cause of the COVID-19 pandemic, is a highly infectious human respiratory pathogen to which the global population had no prior immunity. The virus will likely continue to cause significant morbidity until there is a broadly effective vaccine As of mid-December 2020, more than 200 COVID-19 vaccine candidates are in development and 11 have entered phase III clinical trials globally. ⋯ The messenger RNA vaccine is being rolled out in the UK, USA and Canada Significant uncertainties remain. How well will some of those at highest risk of severe disease (such as older people aged >75 years and those with immunocompromising conditions) be protected by a vaccine, and for how long? Also, to what extent will vaccination protect against infection? This will determine the degree of indirect 'herd' protection needed through broad vaccine coverage of younger age groups.
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The important first step in the critical appraisal of a randomised trial is not an evaluation of the statistical analyses. The most important aspect to consider when reviewing a study of a new drug is the appropriateness and quality of the trial design and methods The next most important aspect is the effect size of different treatments and its clinical significance. Rather than reporting statistical significance, studies should report the difference between treatments and its precision Over-reliance on statistical significance and p values may lead to incorrect conclusions. Trial reports about drugs should therefore avoid the term statistical significance and quote p values with caution.
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A biopsychosocial and lifestyle approach should be used when managing depression. Many patients seen in primary care do not require drug therapy Evidence-based treatments such as psychological therapies and antidepressant drugs are effective for depression. All patients should receive education about depression Shared decision making with the patient is critical if an antidepressant is prescribed. The choice of antidepressant depends on its efficacy and tolerability, the depressive presentation, patient preference and drug interactions.
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Most patients with dementia have behavioural and psychological symptoms. The first-line treatments for these symptoms are not drugs, but behavioural and psychological interventions Antipsychotic drugs are widely prescribed for people living with dementia. ⋯ Trials of deprescribing are therefore recommended Behaviours should be seen as symptoms that have an underlying cause. Treatment should target these causes, rather than the resultant behaviours.