Blog
Clinical evidence insights, methodology deep-dives, and the latest in clinical decision support from the Ailva team.
Treatment-Resistant Depression: Augmentation Strategies and Emerging Therapies
One-third of patients with major depressive disorder do not respond to first-line antidepressants. This review covers evidence-based augmentation strategies including lithium, atypical antipsychotics, ketamine/esketamine, and psilocybin-assisted therapy.
JAK Inhibitor Safety in Rheumatology: Navigating the ORAL Surveillance Aftermath
The ORAL Surveillance trial raised cardiovascular and malignancy concerns for JAK inhibitors in RA. This review examines the current safety landscape, appropriate patient selection, and how to position JAK inhibitors in the rheumatologic treatment algorithm.
Thyroid Nodule Evaluation: Bethesda Classification, Molecular Testing, and When to Biopsy
Thyroid nodules are detected in up to 68% of adults on high-resolution ultrasound, yet fewer than 5% harbor malignancy. This review covers the ACR TI-RADS system for biopsy decision-making, Bethesda cytopathology classification, and the role of molecular testing in indeterminate nodules.
Pulmonary Embolism Risk Stratification: PESI, sPESI, and Outpatient Management
Risk stratification drives PE management from thrombolysis in massive PE to outpatient anticoagulation in low-risk PE. This review covers PESI/sPESI scoring, RV dysfunction assessment, the Hestia criteria for outpatient eligibility, and evolving evidence for intermediate-risk PE management.
Pediatric Asthma: Step Therapy Guidelines and Biologic Eligibility Criteria
GINA and NAEPP guidelines define a stepwise approach to pediatric asthma with recent updates incorporating biologics for severe persistent disease. This review covers step therapy from ages 6-17, ICS dosing thresholds, and eligibility criteria for omalizumab, mepolizumab, dupilumab, and tezepelumab.
Prostate Cancer Screening: USPSTF Updates, MRI Integration, and Shared Decision-Making
Prostate cancer screening with PSA remains controversial despite updated USPSTF recommendations supporting informed decision-making for men aged 55-69. This review covers the evolving role of prebiopsy MRI, risk calculators, and active surveillance strategies that have changed the risk-benefit calculus.
Major Depressive Disorder in Adolescents: SSRI Selection, Monitoring, and Suicidality Risk
Treating adolescent depression requires balancing evidence for SSRI efficacy against the FDA black box warning for suicidality. This review covers first-line SSRI selection, the TADS and TORDIA trial evidence, monitoring protocols, and combination with psychotherapy.
Breast Cancer Screening: Mammography Guidelines and Risk-Based Approaches
Breast cancer screening guidelines diverge across major organizations on starting age, screening interval, and integration of supplemental modalities. This review synthesizes USPSTF, ACS, and ACR recommendations, evaluates risk-stratified screening models, and reviews emerging evidence for contrast-enhanced mammography and abbreviated MRI.
Lung Cancer Screening: LDCT Criteria and Shared Decision-Making
Low-dose computed tomography screening reduces lung cancer mortality by 20-24% in high-risk populations. This review covers the 2024 USPSTF eligibility criteria, Lung-RADS reporting, nodule management algorithms, and strategies for effective shared decision-making in primary care.
Preeclampsia Prevention and Management: Aspirin Prophylaxis Evidence
Low-dose aspirin prophylaxis reduces preeclampsia risk by 24-62% in high-risk pregnancies when initiated before 16 weeks gestation. This review covers risk stratification, the ASPRE trial findings, optimal dosing, and management of established preeclampsia including magnesium sulfate protocols.
Colorectal Cancer Screening: Age 45 Start and Stool-Based vs Colonoscopy
The lowered screening age to 45 and expansion of stool-based testing options have reshaped the CRC screening landscape. This review compares colonoscopy, FIT, FIT-DNA (Cologuard), and emerging blood-based tests, with guidance on selecting the optimal strategy for individual patients.
Thyroid Cancer: Active Surveillance vs Surgery for Low-Risk Papillary
Active surveillance for low-risk papillary thyroid microcarcinoma has demonstrated oncologic safety comparable to immediate surgery in landmark Japanese trials. This review covers patient selection criteria, monitoring protocols, and triggers for delayed surgical intervention.
Bipolar Disorder Pharmacotherapy: Lithium, Valproate, and Atypical Antipsychotics
Mood stabilizer selection in bipolar disorder depends on episode polarity, comorbidities, and patient-specific risk factors. This review compares lithium, valproate, and atypical antipsychotics across acute mania, bipolar depression, and maintenance phases with trial-level evidence.
Bone Health in Premenopausal Women: When to Screen and How to Treat
Osteoporosis in premenopausal women is uncommon but clinically significant when present, requiring a fundamentally different diagnostic and therapeutic approach than in postmenopausal patients. This review covers appropriate indications for DXA screening, secondary cause evaluation, and treatment options.
Polycystic Ovary Syndrome: Metabolic Risk and Treatment Algorithm
PCOS affects 8-13% of reproductive-age women and is the most common cause of anovulatory infertility. The 2023 International Evidence-Based Guideline updates diagnostic criteria and emphasizes metabolic risk assessment as a cornerstone of management.
Iron Deficiency Anemia: IV Iron Formulations and Indications
Iron deficiency is the most common nutritional deficiency worldwide, affecting an estimated 1.2 billion people. Intravenous iron formulations now allow complete repletion in 1-2 infusions, fundamentally changing management for patients with malabsorption, intolerance to oral iron, or ongoing losses.
Chronic Kidney Disease-Mineral Bone Disorder: Phosphate Management
CKD-mineral and bone disorder (CKD-MBD) begins early in CKD and drives cardiovascular calcification and fracture risk. Phosphate management, guided by the 2024 KDIGO update, integrates dietary modification, phosphate binders, and novel therapies targeting FGF23 and the phosphate-kidney axis.
Neonatal Sepsis: Early vs Late Onset and Empiric Antibiotic Selection
Neonatal sepsis remains a leading cause of morbidity and mortality in the NICU, with early-onset sepsis occurring within 72 hours and late-onset sepsis after 72 hours of life. This review covers risk stratification tools, empiric antibiotic regimens, and evidence for antibiotic duration.
Hereditary Cancer Syndromes: When to Test and Surveillance Guidelines
Hereditary cancer syndromes account for 5-10% of all cancers. Expanded multigene panel testing has identified at-risk individuals earlier, but appropriate patient selection, variant interpretation, and risk-stratified surveillance protocols remain essential for clinical benefit.
Contrast-Induced Nephropathy: Prevention Strategies and Risk Assessment
The risk of contrast-induced nephropathy has been overstated in historical literature, with contemporary evidence suggesting true incidence is significantly lower than previously reported. This review covers updated risk stratification, evidence-based prevention strategies, and guideline recommendations.
How to Verify Medical Citations: A Step-by-Step Guide
A practical, step-by-step guide for physicians to verify whether a medical citation is real, accurate, and correctly attributed — whether it comes from a clinical tool, a colleague, or a published review.
Understanding Preprint Evidence: What Clinicians Need to Know
One-third of practicing physicians have used a preprint to inform a clinical decision. One preprint — dexamethasone in severe COVID — saved thousands of lives by bypassing the publication timeline. Another — hydroxychloroquine — caused widespread harm. The format is neutral. The quality of the science is what matters.
Can Physicians Trust Clinical Intelligence Tools? An Evidence-Based Framework
Physician trust in clinical tools should be earned through transparency, verification, and evidence — not marketing. Here is a framework for evaluating whether a clinical intelligence tool deserves your trust.
Evidence-Based Medicine in the Age of Information Overload: A Physician's Survival Guide
With 1.5 million new medical articles published annually, staying current with evidence-based medicine is impossible through traditional methods. A practical guide for managing medical information overload without compromising patient care.
Shared Decision-Making with Complex Evidence: A Practical Guide
Shared decision-making works best when the evidence is clear. It matters most when the evidence is not. Here is a framework for communicating NNT, NNH, uncertainty, and conflicting data to patients who need to make real decisions.
The Bench-to-Bedside Gap: Why Evidence Takes 17 Years to Reach Patients
SGLT2 inhibitors have a Class I recommendation for heart failure. Only 13% of eligible patients are on one. The gap between what the evidence shows and what patients receive is measured in decades and tens of thousands of lives. Here is where the years go.
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