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July 2020 Briefing - Pulmonology

Last Updated: August 03, 2020.

Here are what the editors at HealthDay consider to be the most important developments in Pulmonology for July 2020. This roundup includes the latest research news from journal articles, as well as the FDA approvals and regulatory changes that are the most likely to affect clinical practice.

Physician's Briefing Weekly Coronavirus Roundup

Here is what the editors at Physician's Briefing chose as the most important COVID-19 developments for you and your practice for the week of July 27 to 31, 2020. This roundup includes the latest research news from journal studies and other trusted sources that is most likely to affect clinical practice.

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U.S. Puts Up Another $2.1 Billion for Potential COVID-19 Vaccine

FRIDAY, July 31, 2020 (HealthDay News) -- The United States is buying up another potential COVID-19 vaccine, the Associated Press reported Friday.

AP News Article

Telemedicine Use Explodes During COVID-19 Pandemic

FRIDAY, July 31, 2020 (HealthDay News) -- The emergence of telemedicine has accelerated during the coronavirus pandemic. HD Live! sat down with Rujuta Saksena, M.D., an oncologist at Overlook Medical Center in Summit, New Jersey, and Ateev Mehrotra, M.D., associate professor of health care policy at Harvard Medical School in Boston, to discuss the future of telemedicine and its impact on health care.

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Plenty of COVID-19 Vaccine Coming, Fauci Says

FRIDAY, July 31, 2020 (HealthDay News) -- When a COVID-19 vaccine is approved, there should be plenty of it available, Anthony Fauci, M.D., infectious diseases chief at the U.S. National Institutes of Health, told a House panel Friday, the Associated Press reported.

AP News Article
Johns Hopkins University

Global Epidemiology of COVID-19 Reported for Prepandemic Era

FRIDAY, July 31, 2020 (HealthDay News) -- Many of the first COVID-19 cases reported from affected countries outside of mainland China involved recent travel to affected countries, according to a study published online July 29 in The Lancet Infectious Diseases.

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Survivors of Adolescent, Young Adult ALL May Suffer Late Effects

FRIDAY, July 31, 2020 (HealthDay News) -- Survivors of adolescent and young adult (AYA) acute lymphoblastic leukemia (ALL) may experience late effects, with a high incidence of subsequent endocrine disease and cardiac disease, according to a study published in the August issue of JNCI Cancer Spectrum.

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Bacterial, Fungal Coinfection Uncommon in COVID-19 Patients

FRIDAY, July 31, 2020 (HealthDay News) -- Bacterial and fungal infections are uncommon in hospitalized COVID-19 patients, but coinfection is associated with high mortality and antibiotic use is widespread, according to a study published in the July issue of Infection Control & Hospital Epidemiology.

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Sex Differences in Income Vary With Proportion of Male Doctors

FRIDAY, July 31, 2020 (HealthDay News) -- For surgical and nonsurgical specialists, sex differences in income vary with the proportion of male physicians in a practice, according to a study published online July 30 in The BMJ.

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School Closures Linked to Decreased COVID-19 Incidence, Death

THURSDAY, July 30, 2020 (HealthDay News) -- School closures in the United States were temporally associated with decreased COVID-19 incidence and mortality, according to a study published online July 29 in the Journal of the American Medical Association.

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Remdesivir Shortages Plague Some Hospitals, Pharmacists Say

THURSDAY, July 30, 2020 (HealthDay News) -- One-third of pharmacists say they do not have enough remdesivir to treat all COVID-19 patients who are eligible for it, according to the results of a survey released by the American Society of Health-System Pharmacists (ASHP).

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Nirsevimab Injection Cuts RSV-Linked Infections in Preemies

THURSDAY, July 30, 2020 (HealthDay News) -- Nirsevimab prevents respiratory syncytial virus (RSV)-associated lower respiratory tract infections in healthy preterm infants, while maternal RSV fusion (F) protein nanoparticle vaccination did not meet the prespecified criterion for efficacy, according to two studies published in the July 30 issue of the New England Journal of Medicine.

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Delayed Treatment of Upper Respiratory Tract Infections Tied to Hospitalization Risk

THURSDAY, July 30, 2020 (HealthDay News) -- Delayed treatment of upper respiratory tract infections (URTI) with antibiotics is associated with an increased risk for hospital admissions, according to a study published online June 29 in Clinical Infectious Diseases.

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Posthospital Follow-Up Visits for Bronchiolitis May Not Be Needed

WEDNESDAY, July 29, 2020 (HealthDay News) -- As-needed follow-up is an equally effective posthospitalization follow-up strategy when compared with a scheduled follow-up visit for young children hospitalized for bronchiolitis, according to a study published online July 6 in JAMA Pediatrics.

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Obesity in Young Adulthood Tied to Later Venous Thromboembolism

WEDNESDAY, July 29, 2020 (HealthDay News) -- Men who are obese or severely obese in young adulthood have an increased risk for venous thromboembolism (VTE) later in life, according to a study published in the June issue of the Journal of Internal Medicine.

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Depression, Anxiety May Be Signs That COVID-19 Is Attacking Brain

WEDNESDAY, July 29, 2020 (HealthDay News) -- Depression and anxiety exhibited in COVID-19 patients may be a sign that the virus impacts the central nervous system, as these symptoms are closely associated with a loss of smell and taste rather than more severe manifestations of the virus, according to a study published online July 2 in The Laryngoscope.

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Latino Communities at Higher Risk for COVID-19

WEDNESDAY, July 29, 2020 (HealthDay News) -- Factors linked to structural racism and social determinants of health are associated with an increased risk for COVID-19 in Latino communities, according to a study published online July 23 in the Annals of Epidemiology.

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FDA Warns Again About Dangers of Methanol-Based Hand Sanitizers

TUESDAY, July 28, 2020 (HealthDay News) -- The U.S. Food and Drug Administration is warning consumers not to use alcohol-based hand sanitizers containing methanol, or wood alcohol, which is used in fuel and antifreeze and is toxic if absorbed through the skin or life-threatening if ingested.

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COVID-19 Vaccine Candidate Now in Final Phase Testing

MONDAY, July 27, 2020 (HealthDay News) -- A vaccine developed by the U.S. National Institutes of Health and Moderna has entered the final phase of testing, the Associated Press reported Monday.

AP News Article

CDC to Address Inequalities in COVID-19 Reporting

MONDAY, July 27, 2020 (HealthDay News) -- The U.S. Centers for Disease Control and Prevention plans to take steps to improve how it collects COVID-19 data for blacks, Hispanics, and Native Americans, the Associated Press reports.

AP News Article

COVID-19 Can Result in Prolonged Illness Even in Milder Cases

MONDAY, July 27, 2020 (HealthDay News) -- Even among persons with milder outpatient illness, COVID-19 can result in prolonged illness, according to research published in the July 24 early-release issue of the U.S. Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report.

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Large Proportion of COVID-19 Studies Have Low-Level Evidence

MONDAY, July 27, 2020 (HealthDay News) -- A large proportion of studies on COVID-19 have a low level of evidence, according to a research letter published online July 27 in JAMA Internal Medicine.

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Physician's Briefing Weekly Coronavirus Roundup

Here is what the editors at Physician's Briefing chose as the most important COVID-19 developments for you and your practice for the week of July 20 to 24, 2020. This roundup includes the latest research news from journal studies and other trusted sources that is most likely to affect clinical practice.

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CDC Guidance Issued for Testing, Management of HCP Exposed to Hep C

FRIDAY, July 24, 2020 (HealthDay News) -- In a U.S. Centers for Disease Control and Prevention guidance report, published in the July 24 issue of Morbidity and Mortality Weekly Report, recommendations are presented for testing and clinical management of health care personnel (HCP) exposed to the hepatitis C virus (HCV).

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New Guidelines Released for Recovering COVID-19 Patients to Leave Isolation

THURSDAY, July 23, 2020 (HealthDay News) -- Many recovering COVID-19 patients in the United States will now be able to leave isolation without further testing to show they are virus-free, the U.S. Centers for Disease Control and Prevention said Wednesday.

The New York Times Article

High Prevalence of Americans Have Conditions Linked to Severe COVID-19

THURSDAY, July 23, 2020 (HealthDay News) -- The median prevalence of any underlying medical condition that increases the risk for severe COVID-19-associated illness is 47.2 percent among residents in all 50 states and the District of Columbia, according to research published in the July 24 issue of the U.S. Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report.

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U.S. Nursing Homes Get Another $5 Billion to Fight COVID-19

THURSDAY, July 23, 2020 (HealthDay News) -- U.S. nursing homes will receive another $5 billion to help them fight the COVID-19 pandemic, the Trump administration announced Wednesday.

AP News Article

Three in Four Americans Favor Face Coverings: Survey

THURSDAY, July 23, 2020 (HealthDay News) -- Face coverings should be worn by people when they leave home, three-quarters of Americans say in a new poll.

AP News Article

Financial Health of Hospitals 'Dire' Due to COVID-19

THURSDAY, July 23, 2020 (HealthDay News) -- COVID-19 continues to cause financial peril for U.S. hospitals, according to a report released by the American Hospital Association (AHA).

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Most Individuals in U.S. Have Not Been Infected With SARS-CoV-2

THURSDAY, July 23, 2020 (HealthDay News) -- During March to early May 2020, most individuals in the United States had not been infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), although the estimated number of infections seems to have been much higher than the number of reported cases, according to a study published online July 21 in JAMA Internal Medicine.

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Ad5-Vectored COVID-19 Vaccine Immunogenic in Healthy Adults

THURSDAY, July 23, 2020 (HealthDay News) -- The nonreplicating adenovirus type-5 (Ad5)-vectored COVID-19 vaccine appears safe and induces immune responses at a dose of 5×1010 viral particles, according to a study published online July 20 in The Lancet.

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Varenicline Strongly Recommended for Smoking Cessation

THURSDAY, July 23, 2020 (HealthDay News) -- Varenicline is strongly recommended over the patch for adult smokers hoping to quit, according to an American Thoracic Society practice guideline published online in the July 15 issue of the American Journal of Respiratory and Critical Care Medicine.

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U.S. Reaches Deal for Nearly 600 Million Doses of COVID-19 Vaccine

WEDNESDAY, July 22, 2020 (HealthDay News) -- A nearly $2 billion contract with pharmaceutical company Pfizer and a German biotechnology firm will provide the United States with up to 600 million doses of a COVID-19 vaccine being developed by the companies, the U.S. government says.

The New York Times Article

Elective Services in Pulmonary, Sleep Medicine to Resume During COVID-19

WEDNESDAY, July 22, 2020 (HealthDay News) -- In a guidance document issued by an American Thoracic Society-led international task force, published online July 14 in the Annals of the American Thoracic Society, recommendations are presented for the resumption of elective in-person clinical services in pulmonary and sleep medicine.

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CDC: Former Smokers Have Higher Levels of Fair, Poor Health

WEDNESDAY, July 22, 2020 (HealthDay News) -- Smoking cessation is beneficial, but even after cessation, former smokers have worse health measures, according to a study published online July 22 in National Health Statistics Reports, a publication from the U.S. Centers for Disease Control and Prevention.

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11.8 Percent of Household Contacts of Index Patients Have COVID-19

TUESDAY, July 21, 2020 (HealthDay News) -- Overall, 11.8 percent of household contacts of index COVID-19 patients in South Korea have COVID-19 compared with 1.9 percent of nonhousehold contacts, according to a study published online July 16 in Emerging Infectious Diseases, a publication of the U.S. Centers for Disease Control and Prevention.

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Rise in Avoidable Cancer Deaths Expected Due to COVID-19

TUESDAY, July 21, 2020 (HealthDay News) -- An increase in the number of avoidable cancer deaths is expected in England as a result of diagnostic delays due to the COVID-19 pandemic, according to a study published online July 20 in The Lancet Oncology.

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U.K. Study Looks at Stepping Down Meds in Stable Asthma

TUESDAY, July 21, 2020 (HealthDay News) -- Asthma patients are increasingly prescribed higher levels of treatment, and few patients step down medications, according to a study published online July 21 in PLOS Medicine.

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Even Mild Obesity Tied to Significantly Worse COVID-19 Outcomes

TUESDAY, July 21, 2020 (HealthDay News) -- Obesity is a strong, independent risk factor for poor outcomes among COVID-19 patients, according to a study published July 1 in the European Journal of Endocrinology.

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Blood Type Not Linked to Progression to Severe COVID-19

TUESDAY, July 21, 2020 (HealthDay News) -- For COVID-19 patients, blood type is not associated with the risk for progression to severe disease, according to a study published online July 12 in the Annals of Hematology.

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Review: In-ICU Mortality for COVID-19 Down to 41.6 Percent

TUESDAY, July 21, 2020 (HealthDay News) -- The in-intensive care unit (ICU) mortality from COVID-19 is lower than initially thought, with a combined mortality of 41.6 percent based on 24 studies, according to a review published online June 30 in Anaesthesia.

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Demographic, Clinical, Hospital Factors Tied to COVID-19 Death

MONDAY, July 20, 2020 (HealthDay News) -- For COVID-19 patients in the intensive care unit (ICU), demographic, clinical, and hospital-level risk factors are associated with death, according to a study published online July 15 in JAMA Internal Medicine.

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FDA Issues Warning Letters Regarding Illegal Sales of Vape Products

MONDAY, July 20, 2020 (HealthDay News) -- Ten companies have been ordered to remove their flavored disposable e-cigarettes and e-liquid products from the market, the U.S. Food and Drug Administration says.

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Exercise Helps Prevent High BP Even in Areas of High Air Pollution

MONDAY, July 20, 2020 (HealthDay News) -- Regular physical activity (PA) still provides benefit against hypertension even in areas of high air pollution, according to a study published online July 20 in Circulation.

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Reducing Testing Delay Crucial for Slowing COVID-19 Transmission

MONDAY, July 20, 2020 (HealthDay News) -- Minimizing testing delay has the largest impact on reducing onward transmission of COVID-19, according to a study published online July 16 in The Lancet Public Health.

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28-Day Mortality in COVID-19 Lower With Dexamethasone

MONDAY, July 20, 2020 (HealthDay News) -- Dexamethasone lowers 28-day mortality in patients hospitalized with COVID-19 who are receiving invasive mechanical ventilation or oxygenation alone, according to a study published online July 17 in the New England Journal of Medicine.

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Ban on Menthol Cigarettes Might Cut Smoking Rates in the U.S.

MONDAY, July 20, 2020 (HealthDay News) -- Extending the U.S. cigarette flavor ban to include menthol products could promote smoking cessation and reduce initiation, according to a review published online July 9 in BMC Public Health.

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Physician's Briefing Weekly Coronavirus Roundup

Here is what the editors at Physician's Briefing chose as the most important COVID-19 developments for you and your practice for the week of July 13 to 17, 2020. This roundup includes the latest research news from journal studies and other trusted sources that is most likely to affect clinical practice.

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CDC Will Again Post COVID-19 Hospitalization Data

FRIDAY, July 17, 2020 (HealthDay News) -- In a quick policy reversal, the Trump administration on Thursday told the U.S. Centers for Disease Control and Prevention to once again post data about COVID-19 hospitalizations on its website.

CNN Article

3M Sues Over Fake N95 Masks, Price Gouging

FRIDAY, July 17, 2020 (HealthDay News) -- 3M says it has filed 18 lawsuits in relation to price gouging, counterfeiting, and fraud related to its N95 masks.

AP News Article

Call for 'Challenge Trials' to Hasten COVID-19 Vaccine Development

FRIDAY, July 17, 2020 (HealthDay News) -- The U.S. government should make immediate preparations for clinical trials in which volunteers are exposed to the new coronavirus to speed development of a vaccine, more than 100 top scientists say in a letter to the U.S. National Institutes of Health.

CNN Article

Lack of Public Education for Using Face Masks Leads to Noncompliance, Experts Warn

FRIDAY, July 17, 2020 (HealthDay News) -- A nationwide, coordinated effort is needed to successfully implement widespread wearing of face masks to help slow the spread of COVID-19, according to Robert Brook, M.D., professor of medicine at UCLA and distinguished chair in the health care services program at the RAND Corporation, and May Chu, Ph.D., clinical professor of epidemiology with the Colorado School of Public Health at the University of Colorado Anschutz Medical Campus. They recently spoke with HD Live! about the impending consequences of nonmasking and possible strategies to improve compliance.

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Variety of Symptoms Reported for COVID-19 Patients

FRIDAY, July 17, 2020 (HealthDay News) -- Nearly all symptomatic COVID-19 patients experience fever, cough, or shortness of breath, and a wide variety of other symptoms are reported, according to research published July 17 in the U.S. Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report.

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Exposure to Wildfire Smoke Ups Deaths of Hemodialysis Patients

FRIDAY, July 17, 2020 (HealthDay News) -- For patients receiving in-center hemodialysis, exposure to fine particulate matter (PM2.5) from wildfire is associated with all-cause mortality, according to a study published online July 16 in the Journal of the American Society of Nephrology.

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U.S. Must Spend $75 Billion to Improve COVID-19 Testing, Report Says

THURSDAY, July 16, 2020 (HealthDay News) -- The United States faces "an impending disaster" from the coronavirus pandemic and should spend $75 billion to improve its diagnostic testing system for COVID-19, a Rockefeller Foundation report says.

STAT News Article
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Higher SARS-CoV-2 Viral Load Tied to Shorter Symptom Duration

THURSDAY, July 16, 2020 (HealthDay News) -- Viral load (VL) of severe acute respiratory syndrome coronavirus 2 is lower in hospitalized patients, and higher VL is associated with a shorter duration of symptoms and hospital stay, according to a study published online July 2 in The American Journal of Pathology.

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Physical Distancing Interventions Cut Incidence of COVID-19

THURSDAY, July 16, 2020 (HealthDay News) -- Physical distancing interventions are associated with a reduced incidence of COVID-19 globally, according to a study published online July 15 in The BMJ.

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SARS-CoV-2 mRNA-1273 Induces Immune Response

THURSDAY, July 16, 2020 (HealthDay News) -- The candidate vaccine mRNA-1273, which encodes the stabilized prefusion severe acute respiratory syndrome coronavirus 2 spike protein, induces immune responses in healthy participants, according to a phase 1 study published online July 14 in the New England Journal of Medicine.

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Nonsmoking Young Adults Less Vulnerable to Severe COVID-19

THURSDAY, July 16, 2020 (HealthDay News) -- Nonsmoking young adults have lower medical vulnerability to severe COVID-19 illness, according to a study published online July 13 in the Journal of Adolescent Health.

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Impact of COVID-19 Estimated on HIV, TB, Malaria Services

THURSDAY, July 16, 2020 (HealthDay News) -- Disruption to services for HIV, tuberculosis, and malaria due to COVID-19 could lead to considerable loss of life in low- and middle-income countries, according to a study published online July 13 in The Lancet Global Health.

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CDC Will No Longer Receive Hospitals' COVID-19 Data

WEDNESDAY, July 15, 2020 (HealthDay News) -- U.S. hospitals have been told by the Trump administration to send all COVID-19 information to a central database in Washington, D.C., instead of to the U.S. Centers for Disease Control and Prevention.

The New York Times Article

COVID-19 Vaccine Initiative May Favor Rich Countries

WEDNESDAY, July 15, 2020 (HealthDay News) -- A global COVID-19 vaccine initiative has been formed with the objective of ensuring fair distribution of vaccines worldwide, but it may benefit rich countries more than poor nations.

AP News Article

Global Population Anticipated to Peak in 2064

WEDNESDAY, July 15, 2020 (HealthDay News) -- The global population is anticipated to peak in 2064 and then decline to year 2100, according to a study published online July 14 in The Lancet.

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Lymphocytopenia May Predict Greater Severity in COVID-19

WEDNESDAY, July 15, 2020 (HealthDay News) -- Lymphocytopenia may be predictive of disease severity in patients with COVID-19, according to a study published online July 10 in the International Journal of Laboratory Hematology.

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Most U.S. COVID-19-Related Deaths Occur in Medical Facility

WEDNESDAY, July 15, 2020 (HealthDay News) -- Most COVID-19-related deaths in the United States occur in a medical facility, according to a study published online July 9 in the Journal of the American Geriatrics Society.

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Survival Up With Tocilizumab in Ventilated COVID-19 Patients

WEDNESDAY, July 15, 2020 (HealthDay News) -- For patients with COVID-19 requiring mechanical ventilation, tocilizumab is associated with improved survival, according to a study published online July 11 in Clinical Infectious Diseases.

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Poor Sleep Patterns May Up Risk for Attacks in Adults With Asthma

WEDNESDAY, July 15, 2020 (HealthDay News) -- Too little sleep or too much sleep is tied to more asthma attacks in adults, according to a study recently published in the Annals of Allergy, Asthma & Immunology.

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No COVID-19 Deaths Reported in NYC for First Time in Months

TUESDAY, July 14, 2020 (HealthDay News) -- New York City -- once the COVID-19 epicenter in the United States -- has marked a major achievement.

AP News Article

Layoffs Cost 5.4 Million Americans Their Health Insurance

TUESDAY, July 14, 2020 (HealthDay News) -- About 5.4 million Americans lost their health insurance after being laid off between February and May due to the COVID-19 pandemic, a new study shows.

The New York Times Article

Symptom-Based Testing Not Adequate for Detecting COVID-19

TUESDAY, July 14, 2020 (HealthDay News) -- Using symptom-based testing alone is not adequate for identifying COVID-19 cases in long-term care facilities, according to a research letter published online July 14 in JAMA Internal Medicine.

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Shelter-in-Place Orders Cut Growth Rates of COVID-19 Deaths

TUESDAY, July 14, 2020 (HealthDay News) -- Shelter-in-place orders (SIPOs) reduced the daily growth rates of COVID-19 deaths and hospitalizations, according to a report published online July 9 in Health Affairs.

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Outcomes Worse for COVID-19-Linked Ischemic Strokes

TUESDAY, July 14, 2020 (HealthDay News) -- COVID-19-associated ischemic strokes are more severe than non-COVID-19 ischemic strokes, with worse functional outcome and increased mortality, according to a study published online July 9 in Stroke.

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Commercially Viable Mobile Lung Screening Program Feasible

TUESDAY, July 14, 2020 (HealthDay News) -- Developing a commercially viable and financially sound mobile program for lung screening is feasible, according to a study published online July 14 in the Annals of Thoracic Surgery.

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Rise Seen in U.S. COVID-19 Deaths

MONDAY, July 13, 2020 (HealthDay News) -- Led by states in the South and West, COVID-19 deaths in the United States have started a long-anticipated increase, data show.

AP News Article

Slow Test Results Hampering U.S. Fight Against COVID-19

MONDAY, July 13, 2020 (HealthDay News) -- Test results for the new coronavirus are taking so long that they are doing little to help stop the spread of the virus in the United States, experts say.

Washington Post Article

Some Hospitals in COVID-19 Hotspots Running Short of Remdesivir

MONDAY, July 13, 2020 (HealthDay News) -- Some U.S. hospitals in COVID-19 hotspots are running short of the antiviral drug remdesivir -- the only drug authorized by the U.S. Food and Drug Administration to treat the disease -- while hospitals in other regions have stocks of the drug that are going unused.

CNN Article

Black Individuals at Increased Risk for SARS-CoV-2 Infection

MONDAY, July 13, 2020 (HealthDay News) -- Black individuals are at increased risk for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and hospitalization, according to a letter to the editor published online July 9 in the Annals of the American Thoracic Society.

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COVID-19 Case Rates, Deaths Considerably Higher in Prisons

MONDAY, July 13, 2020 (HealthDay News) -- COVID-19 case rates are substantially higher in prisons than in the U.S. population and are escalating rapidly, according to a research letter published online July 8 in the Journal of the American Medical Association.

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COVID-19-Related Symptoms Persist After Recovery

MONDAY, July 13, 2020 (HealthDay News) -- Most patients who have recovered from COVID-19 report persistence of at least one symptom, according to a research letter published online July 9 in the Journal of the American Medical Association.

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Baloxavir Protects Household Contacts From Influenza

MONDAY, July 13, 2020 (HealthDay News) -- Baloxavir demonstrates postexposure prophylactic efficacy for preventing influenza in household contacts of index patients, according to a study published online July 8 in the New England Journal of Medicine.

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Maternal Allergy, Asthma Traits Up Child Risk in Early Years

MONDAY, July 13, 2020 (HealthDay News) -- In early life, maternal history of allergies and asthma confers a stronger effect on a child's risk for developing the same traits compared with the father's history, according to a study published online July 7 in Clinical & Experimental Allergy.

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Physician's Briefing Weekly Coronavirus Roundup

Here is what the editors at Physician's Briefing chose as the most important COVID-19 developments for you and your practice for the week of July 6 to 10, 2020. This roundup includes the latest research news from journal studies and other trusted sources that is most likely to affect clinical practice.

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