A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices
Vinay Prasad,Andrae Vandross,Caitlin Toomey,Michael Cheung,Jason Rho,Steven Quinn,Satish Jacob Chacko,Durga S. Borkar,Victor Gall,Senthil Selvaraj,Nancy Ho,Adam S. Cifu +11 more
- Vol. 88, Iss: 8, pp 790-798
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TLDR
The reversal of established medical practice is common and occurs across all classes of medical practice, and sheds light on low-value practices and patterns of medical research.Abstract:
Objective: To identify medical practices that offer no net benefits. Methods: We reviewed all original articles published in 10 years (2001-2010) in one high-impact journal. Articles were classified on the basis of whether they addressed a medical practice, whether they tested a new or existing therapy, and whether results were positive or negative. Articles were then classified as 1 of 4 types: replacement, when a new practice surpasses standard of care; back to the drawing board, when a new practice is no better than current practice; reaffirmation, when an existing practice is found to be better than a lesser standard; and reversal, when an existing practice is found to be no better than a lesser therapy. This study was conducted from August 1, 2011, through October 31, 2012. Results: We reviewed 2044 original articles, 1344 of which concerned a medical practice. Of these, 981 articles (73.0%) examined a new medical practice, whereas 363 (27.0%) tested an established practice. A total of 947 studies (70.5%) had positive findings, whereas 397 (29.5%) reached a negative conclusion. A total of 756 articles addressing a medical practice constituted replacement, 165 were back to the drawing board, 146 were medical reversals, 138 were reaffirmations, and 139 were inconclusive. Of the 363 articles testing standard of care, 146 (40.2%) reversed that practice, whereas 138 (38.0%) reaffirmed it. Conclusion: 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.read more
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Evidence-based de-implementation for contradicted, unproven, and aspiring healthcare practices
TL;DR: A conceptual framework is proposed to guide and prioritize this process of abandoning ineffective medical practices, shifting emphasis toward the principles of evidence-based medicine, acknowledging that evidence may still be misinterpreted or distorted by recalcitrant proponents of entrenched practices and other biases.
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Performance of ChatGPT on USMLE: Potential for AI-assisted medical education using large language models
Tiffany H Kung,Morgan Cheatham,Arielle Medenilla,Czarina Sillos,Lorie De Leon,Camille Elepaño,Maria Madriaga,Rimel Aggabao,Giezel Diaz-Candido,James Maningo,Victor Tseng +10 more
TL;DR: The authors evaluated the performance of a large language model called ChatGPT on the United States Medical Licensing Exam (USMLE), which consists of three exams: Step 1, Step 2CK, and Step 3.
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The Strength of Association Between Surrogate End Points and Survival in Oncology: A Systematic Review of Trial-Level Meta-analyses
TL;DR: To identify and evaluate trial-level meta-analyses of randomized clinical trials quantifying the association between a surrogate end point and overall survival in medical oncology, a literature search was built on earlier reported data sets and updated with Google Scholar and MEDLINE searches.
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Towards understanding the de-adoption of low-value clinical practices: a scoping review
Daniel J. Niven,Kelly Mrklas,Jessalyn K. Holodinsky,Sharon E. Straus,Brenda R. Hemmelgarn,Lianne Jeffs,Henry T. Stelfox +6 more
TL;DR: This study proposes a model that providers and decision-makers can use to guide efforts to de-adopt ineffective and harmful practices and identifies a large body of literature that describes current approaches and challenges toDe-adoption of low-value clinical practices.
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