The ability to identify medical reversals and other low-value medical practices is an essential prerequisite for efforts to reduce spending on such practices. Through an analysis of more than 3000 randomized controlled trials (RCTs) published in three leading medical journals (the Journal of the American Medical Association, the Lancet, and the New England Journal of Medicine), we have identified 396 medical reversals. Most of the studies (92%) were conducted on populations in high-income counties, cardiovascular disease was the most common medical category (20%), and medication was the most common type of intervention (33%).

Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.Disclaimer: Dr Bibbins-Domingo is the former chair of the US Preventive Services Task Force (USPSTF). This article reflects her own work and not the official positions of the USPSTF.

Background Identifying ineffective practices that have been used in oncology is important in reducing wasted resources and harm. We sought to examine the prevalence of practices that are being used but have been shown in RCTs to be ineffective (medical reversals) in published oncology studies. Methods We cross-sectionally analyzed studies published in three high-impact oncology medical journals (2009–2018). We abstracted data relating to the frequency and characterization of medical reversals. Results Of the 64 oncology reversals, medications (44%) represented the most common intervention type (39% were targeted). Fourteen (22%) were funded by pharmaceutical/industry only and 56% were funded by an organization other than pharmaceutical/industry. The median number of years that the practice had been in use prior to the reversal study was 9 years (range 1–50 years). Conclusion Here we show that oncology reversals most often involve the administration of medications, have been practiced for years, and are often identified through studies funded by non-industry organizations.

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ImportanceThe terms “personalized oncology” and “precision oncology” have increased in usage and have generated considerable traction in terms of public attention and research funding. To our knowledge, no prior study has as thoroughly documented the use of the “precision oncology” terminology over the last decade.ObjectiveTo determine how the use of the terms “personalized oncology” and “precision oncology” have changed over time.DesignA retrospective literature analysis using two databases (PubMed and Scopus) over 10 years was performed. Manuscripts using either term “personalized oncology” or “precision oncology” were collected. Manuscripts published in 2011, 2013, 2015, 2017 and through 30 June 2019 were pulled for text analysis. Common reasons for exclusion were if the search term appeared in the institution name only, the search term appeared only in keyword or publication title, or the search term was used to justify the relevance or application of research with no clear definition.SettingManuscripts published and catalogued in PubMed or Scopus.ResultsIn our study, we analysed 399 unique manuscripts published over the last decade. Over time, the terminology has shifted from “personalized oncology” to “precision oncology”. Targeted therapy, molecular biomarker-guided tumour profiling and next generation sequencing (ie, “omics-guided tumor profiling”) are the three most common definitions of the term. While these definitions are somewhat overlapping in concept, over the decade we observed an increase in the number of distinct interpretations of “precision oncology”, ranging from structural biology to clinical practice.Conclusions and relevanceWe have observed that the phrase “precision oncology” is shifting, overlapping and expanding in definition. This all-encompassing approach to defining “precision oncology” ironically renders the term imprecise. Our analysis highlights the inherent challenges in defining novel movements in medicine.

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INTRODUCTION: Procedural sedation is given to reduce patient anxiety, discomfort, pain and to improve outcomes in endoscopy. Data are limited regarding patient satisfaction with endoscopy. Our goal was to evaluate physician perceptions of patient pain and anxiety before and after endoscopy and factors associated with their correlation. METHODS: We performed a prospective study of 233 consecutive patients who received procedural sedation during endoscopy from August to November 2018 at the Portland VA Medical Center. Patients were given a pre-endoscopy survey to assess expectations and a post-endoscopy survey to assess procedural satisfaction, and physician were given a post-endoscopy survey only. Outcomes included expected and actual pain, anxiety, and sedation level during endoscopy and was reported on a scale from 0 to 5. RESULTS: Upper endoscopy, colonoscopy, and bi-directional endoscopy were performed in 30%, 60%, and 10% of cases, with an average procedural time of 19.1 minutes. Midazolam and fentanyl were most commonly used for sedation with an average dose of 4.0 ±0.1 mg and 102.5 ± 2.7 mcg, respectively. A minority of patients reported alcohol, marijuana, non-opiate pain medication, and opiate use (39%, 15%, 19%, and 16%, respectively). Pre-procedural anxiety and expected level of pain significantly improved with patient's post-procedural assessment (Tables 1 and 2). The average difference of anxiety and pain levels pre-endoscopy and post-endoscopy was 0.48 and 0.41, respectively. There was poor concordance between the physician's perceived patient pain and patient reported pain level during endoscopy (61%) with an overall Cohen's kappa of 0.258. Several factors associated with reduced patient and physician pain correlation included the presence of mental health disorders and use of benzodiazepines, SSRI, or SNRI (Table 3). Despite the discordance, the majority of patients reported satisfaction in pain control and would return for a repeat procedure (85% and 95%, respectively). CONCLUSION: Patients reported higher levels of pre-procedure anxiety and expected pain than actual anxiety and pain post-procedure. Physicians have poor concordance with patients with respect to pain levels, especially with more severe pain scores and in the presence of mental health disorders. Patients at high risk for discordance may benefit from more thorough pre-procedural counseling and a lower threshold for escalating doses of sedation during endoscopy.