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1. Diagnosis

Step 1: Pretest probability. Use the Wells score, the revised Geneva score or clinical gestalt. Per ASH, for patients at low (unlikely) VTE risk, using D-dimer as the initial test reduces the need for diagnostic imaging. For patients at high (likely) VTE risk, imaging is warranted.Ashpublicationsashpublications.orgAmerican Society of Hematology 2018 guidelines for management of venous thromboembolism: diagnosis of venous thromboembolismFor patients with a low pretest probability of PE, the ASH guideline panel recommends D-dimer as the initial test, which reduces the need for diagnostic imaging. If probability is high, skip the D-dimer and go straight to imaging.

Step 2: PERC, for low gestalt probability only. If all 8 PERC criteria are negative, you can stop testing. This only holds in low-prevalence settings. One external validation found PERC-negative, low-probability patients still had 6.4% (95% CI: 3.7-10.8%)Sciencedirectsciencedirect.comAmong PERC-negative patients with a low clinical probability, the prevalence of pulmonary embolism was 6.4% (95% CI 3.7-10.8%). PE prevalence, so apply it only where gestalt probability is genuinely low.

Step 3: D-dimer. In patients with low or intermediate probability, a negative D-dimer excludes PE. Above age 50, an age-adjusted cut-off (age × 10 µg/L) keeps sensitivity while sparing many patients imaging.

Step 4: Imaging. CT pulmonary angiography is the test of choice. Use V/Q scanning when contrast or radiation is a concern, such as in pregnancy or renal impairment.

How do I diagnose and manage suspected pulmonary embolism?

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Creatinine clearance

Cockcroft-Gault equation

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Age72years
Weight68kg
Serum creatinine1.4mg/dL
CrCl39mL/min

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trial_data.xlsx
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Analyze the attached oncology trial dataset and make a publication-quality Kaplan-Meier curve

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Here are this week's three most notable papers.

A blood test for Alzheimer pathology. A plasma p‑tau217 immunoassay matched CSF biomarkers in accuracy, with cut-offs that held across cohorts.Jamanetworkjamanetwork.comDiagnostic Accuracy of a Plasma Phosphorylated Tau 217 Immunoassay for Alzheimer Disease PathologyA commercially available plasma p-tau217 immunoassay identified Alzheimer disease pathology with accuracy comparable to CSF biomarkers, and its cut-offs were reproducible across cohorts.

Lecanemab at four years. Patients who stayed on treatment in the Clarity AD extension kept benefiting through 48 months.Wileyalz-journals.onlinelibrary.wiley.comThe Lecanemab Clarity AD Open-Label Extension in Early Alzheimer's Disease: Initial Findings From the 48-Month AnalysisParticipants treated with lecanemab continued to benefit through 48 months of the Clarity AD open-label extension.

Sleep clears amyloid and tau. A night of normal sleep raised morning plasma amyloid beta and tau compared with sleep deprivation.Naturenature.comThe glymphatic system clears amyloid beta and tau from brain to plasma in humansIn a randomized crossover trial of 39 participants, normal sleep increased morning plasma levels of Alzheimer disease biomarkers compared with sleep deprivation.

Every Monday at 7 AM, send me the latest advances in Alzheimer's disease

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Frequently asked questions

What is Almanac and how does it work?

Almanac is AI built for clinical work. It gives you evidence-based answers, powerful workflows, and new ways to use the tools you trust. Every answer is grounded in vetted clinical sources and cited, so you can check the evidence yourself.

Who can use Almanac?

Almanac is built for licensed healthcare professionals in active practice, and for medical students, residents, and fellows in accredited programs. It is not intended to provide medical advice to patients or the general public.

How much does it cost to use?

You can start on the Free plan at no cost. Pro and Max add higher limits and more capability for individual clinicians. See Plans and pricing for details.