A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices

Prasad, Vinay; Vandross, Andrae; Toomey, Caitlin; Cheung, Michael C.; Rho, Jason; Quinn, Steven; Chacko, Satish J; Borkar, Durga S.; Gall, Victor; Selvaraj, Senthil; Ho, Nancy T.; Cifu, Adam S.

doi:10.1016/j.mayocp.2013.05.012

Cited by 305 publications

(214 citation statements)

References 95 publications

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“…9 While one would expect reversals to be infrequent, over the last decade, 40 % of the articles in the New England Journal of Medicine that tested standards of care resulted in reversals in clinical practice protocols. 10 Major changes to guideline recommendations are also common; for example, the 2013 guideline for cholesterol management emphasizes statin therapy based on cardiovascular risk instead of cholesterol levels. 11 This growing aggregation of advances and reversals presents a significant challenge to physicians attempting to stay up to date.…”

Section: Pace Of Change In Medical Practicementioning

confidence: 99%

The Pace of Change in Medical Practice and Health Policy: Collision or Coexistence?

Laiteerapong

Huang

2015

J GEN INTERN MED

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Medical practice and health policy are both changing rapidly. While the adopting of changes is not new for physicians, the pace of change in standards of care, marked by advances and reversals, has accelerated over the course of the past decade. A recurring new theme in medical practice has been an emphasis on tailoring treatment plans to individual patients. Physicians have had to simultaneously absorb new processes in the health care system brought about by the Health Information Technology for Economic and Clinical Health (HITECH) Act in 2009 and the Affordable Care Act (ACA) in 2010. The ability of physicians to maintain standards of care that focus on individual patients may conflict with changes resulting from new health policies that emphasize population health management. Primary care physicians may be one of the few collective voices capable of identifying areas where population-level health policies conflict with the care of individual patients, and policymakers should include practicing primary care physicians in the form of community boards in order to ensure the development of new health policies that provide sustainable high-value patient care.

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Section: Pace Of Change In Medical Practicementioning

confidence: 99%

The Pace of Change in Medical Practice and Health Policy: Collision or Coexistence?

Laiteerapong

Huang

2015

J GEN INTERN MED

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“…The facility of adequate disposable sets for drainage is the counterpart of the easy-to-get US machines, equipped with reliable and suitable convex and linear probes, and set appropriately for superficial and lung imaging. The traps, in these conditions, are not many and the only risky trap is, as above addressed, over-trusting in US criteria not evidencebased and, more important, which are demonstrated to be unreliable when critically re-appraised; reversal of such scarcely validated but recommended practices, which could be harmful for patients, is actively in progress (32,33) also in this field of medicine.…”

Section: Final Recommendationmentioning

confidence: 99%

Transthoracic ultrasound for pleural effusion: traps and tricks

Sperandeo¹

2014

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SummaryPleural effusion is excess fluid that accumulates between the two pleural layers. Excessive amounts of such fluid can impair breathing by limiting the expansion of the lungs during ventilation. Pleural effusion is still usually diagnosed on the basis of medical history and physical examination, and confirmed by chest x-ray. It is observed in many pulmonary and extra-pulmonary disease; its cause can be relatively benign or definitely malign (cancer), and may require drainage for treatment or for achieving a diagnosis which is available at the bedside by physical examination and Thoracic Ultrasound (TUS). Pleural effusion is detected by TUS even when its volume is very little: it is possible to perform and repeat at bedside, by sufficiently trained physicians. Diagnostic intervention procedures are safer if performed using US probes specifically designed for this use, i.e. with a central hole which allows the co-axial passage of the disposable tools for drainage or Fine Needle Aspiration Biopsy (FNAB). Over-trusting in US criteria not evidence-based and, more important, which are demonstrated to be unreliable when critically re-appraised must be discouraged; reversal of such scarcely validated but recommended practices, which could be harmful for patients, is actively in progress also in this field of medicine. No special trick is needed and no actual trap is present when the assessment of pleural effusion is performed by a sufficiently skilled MD and with a reliable and well set echo machine. Echo-assisted thoracentesis is an excellent procedure when appropriately performed in all its phases, which are: choice of the site of insertion, visualization in real-time during the drainage and serial control during lung re-expansion (so as to avoid pneumothorax). KEY WORDS: ultrasound, pleural effusion. Transthoracic ultrasound: overviewThe ultrasound examination in the study of pleuro-pulmonary disease, i.e. Thoracic Ultra-Sound (TUS), is limited by the presence of air in the lungs and by the rib cage (1). As a consequence TUS is not an all purpose tool, drawbacks and appropriate indications must be the cynosure of the pneumologist which relies on TUS for diagnosis and management of patients (2). The presence of the bony structures of the rib cage restricts the success of ultrasound imaging of the pleural surface to about 70% of the total (3). These issues, relating to limitations on the use of ultrasound in the thoracic area, have been known since the ʼ60s, a time when pioneering works were published using A-mode for exploring pleuro-pulmonary structures and, namely, pleural effusion (4), even in comparison with radiological imaging and with a greater sensitivity and specificity (5). Thereafter these advantages were established in the few subsequent years, with minimal further refinements despite the technology of ultrasound equipment has evolved considerably (6, 7): the value of ultrasound examination of the pleura and lungs remains highly underestimated to this day, and overstatements (8) and over- Mini-review...

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“…4,5 Many examples of publication bias have been identified in the general medical literature. Of 487 research projects approved by a local ethics committee in England from 1984-1987, only 52% had been published three to six years later.…”

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confidence: 99%

“…5 Publication bias may well have been the main reason for the initial positive results-results that physicians seized and incorporated into medical practice. Although this may cause substantial cognitive dissonance within many of us, there are several reasons, including publication bias, for considering that much of the research we currently trust may actually be false.…”

mentioning

confidence: 99%

“…L'histoire de la médecine révèle que de nombreuses interventions que nous jugions initialement utiles sur la base d'un seul ECR ont ensuite été déclarées sans intérêt, voire nocives. 5 Un biais de publication peut bien avoir été la raison principale des résultats positifs initiaux, des résultats que les médecins ont retenus et inclus dans la pratique médicale. Bien que cela puisse créer une dissonance cognitive chez beaucoup d'entre nous, il y a de nombreuses raisons (dont le biais de publication) pour envisager qu'une grande partie de la recherche à laquelle nous faisons actuellement confiance pourrait être en réalité fausse.…”

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Publication bias in the anesthesiology literature: shifting the focus from the “positive” to the “truth”

Jones

2016

Can J Anesth/J Can Anesth

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A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices

Abstract: The reversal of established medical practice is common and occurs across all classes of medical practice. This investigation sheds light on low-value practices and patterns of medical research.

Cited by 305 publications

References 95 publications

The Pace of Change in Medical Practice and Health Policy: Collision or Coexistence?

The Pace of Change in Medical Practice and Health Policy: Collision or Coexistence?

Transthoracic ultrasound for pleural effusion: traps and tricks

Publication bias in the anesthesiology literature: shifting the focus from the “positive” to the “truth”

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