![]() Immediate delivery compared with expectant management after preterm pre-labour rupture of the membranes close to term (PPROMT trial): a randomized controlled trial. There were 16 (4.0%) studies that we could not find the source of funding. The breakdown of funding categories were as such ( Supplementary file 1): 253 (63.9%) were from non-industry sources only 88 (22.2%) were from a combination of industry and non-industry sources 36 (9.1%) from industry only sources and 3 (0.8%) from non-industry sources plus insurance company (n = 2) or a development bank (n = 1). ![]() Regarding the type of intervention, medication was the most common (33%, n = 129), followed by a procedure (20%, n = 81), vitamin/supplement (13%, n = 53), device (9%, n = 35) and system intervention (8%, n = 30). Cardiovascular disease was the most common medical category (20%, n = 80), followed by public health/preventive medicine (12%, n = 48), and critical care (11%, n = 45). Most studies (92%, n = 366) were conducted on populations in high-income countries, whereas 8% (n = 30) were done in low- or middle-income countries, including, but not limited to China, India, Malaysia, Ghana Tanzania, and Ethiopia. Reversal study characteristics are described in Table 1. 154 of the reversals (39%) were found in JAMA, 129 (33%) were found in NEJM, and 113 (29%) were found in Lancet. Many of these 396 reversals had been the subject of systematic reviews: in 209 cases (53%) the systematic review confirmed that the medical practice in question was indeed a medical reversal in 109 cases (28%) the results of the systematic review were inconclusive and for 78 cases (20%) there was no systematic review. Resultsĭownload asset Open asset Flowchart of selection process to identify included randomized trials. ![]() It is our hope that, by building on previous efforts in this area ( Prasad et al., 2013), this list will help others to eliminate the use of these practices. Here we report how a systematic search of randomized controlled trials in three leading medical journals – the Journal of the American Medical Association (JAMA), the Lancet, and the New England Journal of Medicine (NEJM) – identified 396 medical reversals. The Choosing Wisely initiative in the US maintains a list of low-value medical practices, but it relies on medical organizations to report such practices and often includes only those practices where there is a high degree of consensus ( Beaudin-Seiler, 2016). For example, Cochrane reviews provide high-quality evidence on medical practices ( Garner et al., 2013), but each review focuses on only one practice and many practices have not been reviewed by Cochrane. It can, however, be difficult to identify medical reversals. Medical reversals are a subset of low-value medical practices and are defined as practices that have been found, through randomized controlled trials, to be no better than a prior or lesser standard of care ( Prasad et al., 2013 Prasad et al., 2011). Identifying and eliminating low-value medical practices will, therefore, reduce costs and improve care. ![]() Such practices can result in physical and emotional harm, undermine public trust in medicine, and have both an opportunity cost ( Korenstein et al., 2018) and a financial cost ( Reid et al., 2016 Beaudin-Seiler, 2016). Low-value medical practices are medical practices that are either ineffective or that cost more than other options but only offer similar effectiveness ( Prasad et al., 2013 Prasad et al., 2011 Schpero, 2014). ![]()
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |