Annals for Educators - July 2025

A Synopsis of the 2025 U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guideline for the Primary Care Management of Asthma

Description: The U.S. Department of Veterans Affairs (VA) and U.S. Department of Defense (DOD) updated the 2019 joint clinical practice guideline (CPG) for the primary care management of asthma. This synopsis provides primary care providers with a summary of the updated 2025 recommendations regarding evaluation and management of veterans and military members with asthma. Methods: In 2024, the VA/DOD convened a guideline work group (WG), including clinical stakeholders, to update the joint VA/DOD guideline and conformed to the National Academy of Medicine's tenets for trustworthy CPGs. The WG drafted 12 key questions, reviewed systematically identified literature (20 July 2018 through 15 May 2024), evaluated the evidence, created algorithms, and advanced 21 evidence-based recommendations in accordance with the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system. Recommendations: The WG strongly recommended inhaled corticosteroids (ICS) and streamlined management of asthma by suggesting a combination of ICS and rapid-onset long-acting β-agonist as both reliever and controller agents and step-up therapy by increasing ICS and/or adding long-acting anticholinergic agents. The WG also supported the management of symptomatic gastroesophageal reflux disease and obesity for better control of asthma. The WG suggested against the use of indoor air filtration devices. Finally, the WG outlined decision points for referral to a subspecialist.

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Cytisinicline for 6 or 12 wk increased smoking cessation rates after treatment and up to 24 wk

Clinical Impact Ratings GIM/FP/GP: 6 out of 7 Public Health: 5 out of 7

Ensuring Safe Practice by Late Career Physicians

Understanding the Potential Net Benefit of Weight Loss in Persons With Osteoarthritis

Annals Video Summary - High-Concentration THC Cannabis Products and Mental Health Outcomes: A Systematic Review

Misconceptions About Whether Seeking Mental Health Care Jeopardizes Lawful Firearm Ownership: A National Survey

Management of Sepsis in Hospitalized Patients

Sepsis is the leading cause of death worldwide. Mortality has improved in the past few decades but remains high, and survivors frequently have long-term complications. Initial diagnostic evaluation focuses on risk stratification and source and pathogen identification. Treatment includes intravenous fluids, vasopressors, steroids if shock is present, antimicrobial therapy targeting the most likely source of infection, and source control. Patients with shock or high-risk organ failure syndromes should be admitted early to an intensive care unit. After initial antimicrobials and resuscitation, care should focus on antimicrobial deescalation, volume management, and high-quality supportive care. Shared decision making about goals of care and transitions is important to support survivors after discharge.

High-Concentration Cannabis Products: Need to Know More About Associated Health Risks