Very interesting, I would love to see what medical practices are used by stroke doctors and the science behind them. But that would be suggesting that our doctors don't know what they are doing.
Our stroke associations should be doing this analysis if they were any good.
One of the reversals here from Table 2.
Mild intraoperative hypothermia during surgery for intracranial aneurysm (Todd et al,
60 2005)Hypothermia
was found to be helpful as a neurosurgical adjunct in 1955, especially
for ischemic and traumatic insults.
At the time of this publication, the
practice was used in nearly 50% of aneurysm surgeries.
61
This large randomized study, the Intraoperative Hypothermia for
Aneurysm Surgery Trial (IHAST), found no improvement in neurologic
outcomes with hypothermia, while noting an increase in bacterial
infections with the intervention .
This probably means we need more studies before we setup all ambulances with hypothermia tools.
I guess I'll quit pushing them.
Do you really think the reversals and inconclusive results are read and understood by all your stroke doctors? I think not.
http://www.mayoclinicproceedings.org/article/S0025-6196%2813%2900405-9/fulltext
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.
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