COVID-19 Diagnostic Testing, Back Pain in Children, Nicotine Replacement Therapy

Welcome to the new AFP Clinical Answers monthly email. We hope you enjoy this resource, which we’ve designed to provide quick, focused, evidence-based answers to key clinical questions, drawn from AFP articles. We welcome your feedback at afpedit@aafp.org. – AFP Editors

How can pretest probability impact the approach to interpreting COVID-19 diagnostic testing?

The pretest probability of COVID-19 should be based on the patient’s exposure to someone with a confirmed or probable case, signs or symptoms of COVID-19, local or population-specific prevalence, and the presence of an alternate diagnosis. A negative molecular or antigen test result might not rule out COVID-19 infection when the pretest probability is high. Physicians should recommend isolation precautions regardless of a negative test result when the pretest probability is high; therefore, physicians should use a symptom-based approach for discontinuing isolation precautions for most patients. Read the full article.

Does combining long-acting and short-acting nicotine replacement therapy (NRT) help patients quit smoking, and is any single form of NRT more effective than another?

Patients using a combination of nicotine patch and fast-acting NRT are more likely to quit smoking than those on any single therapy alone (number needed to treat = 29). Rates of smoking cessation are not significantly different when directly comparing nicotine patches with fast-acting forms (e.g., lozenges, gum, inhalers, sprays), although dropout rates are higher with fast-acting forms. Rates of smoking cessation do not significantly differ among the various fast-acting forms. Read the full article.

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