2019 Update on Medical Overuse: A Review.
2019 Update on Medical Overuse: A Review.
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DOI：
10.1001/jamainternmed.2019.3842
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发表时间：
2019-11-01
影响因子：
39
通讯作者：
Korenstein D
中科院分区：
文献类型：
--
作者：
Morgan DJ;Dhruva SS;Coon ER;Wright SM;Korenstein D
医疗过度使用是造成患者伤害和医疗浪费的重要原因。这项对英语文章的结构化文献综述，辅以对2018年发表的高影响力期刊目录的检查，确定了与医疗过度使用相关的文章。评价文章的方法学质量、临床相关性和对患者的影响。在1499篇候选文献中，839篇涉及医疗过度使用。其中，117篇被认为是最重要的，10篇排名最高的文章由作者共识选择。关于药物过度使用的最重要的文章确定了测试的问题，包括降钙素原不影响下呼吸道感染患者的抗生素持续时间（4.2 vs 4.3天）; 22%至38%的普通磁共振成像或计算机断层扫描研究中存在偶发瘤; 9%死于IV期癌症的妇女仍接受乳房X线检查;计算机断层扫描肺癌筛查为低风险患者提供了稳定的益处和较高的伤害率。与过度治疗相关的文章报告称，急诊诊所通常会过度使用抗生素（在所有访视中，39%的患者接受抗生素治疗），亚临床甲状腺功能减退症的治疗对临床结局没有影响。三项研究强调了应该受到质疑的服务，包括使用阿片类药物治疗慢性非癌症疼痛（荟萃分析发现无临床显著获益），重症监护室患者的应激性溃疡预防（死亡率，泮托拉唑组为31.1%，安慰剂组为30.4%），对于氧水平正常的患者，（死亡相对风险，1.21; 95%CI，1.03-1.43）。一篇政策文章发现，国家医疗责任改革与减少冠状动脉疾病的侵入性检查有关，包括减少24%的血管造影。研究结果表明，许多测试被过度使用，过度治疗很常见，不必要的护理可能导致患者伤害。对这些2018年调查结果的审查旨在为希望减少过度使用和改善患者护理的从业者提供信息。
Medical overuse is an important cause of patient harm and medical waste. This structured literature review of English-language articles supplemented by examination of tables of contents of high-impact journals published in 2018 identified articles related to medical overuse. Articles were appraised for their methodologic quality, clinical relevance, and influence on patients. Of 1499 candidate articles, 839 addressed medical overuse. Of these, 117 were deemed to be most significant, with the 10 highest-ranking articles selected by author consensus. The most important articles on medical overuse identified issues with testing, including that procalcitonin does not affect antibiotic duration in patients with lower respiratory tract infection (4.2 vs 4.3 days); incidentalomas are present in 22% to 38% of common magnetic resonance imaging or computed tomography studies; 9% of women dying of stage IV cancer are still screened with mammography; and computed tomography lung cancer screening offers stable benefit and higher rates of harm for patients at lower risk. Articles related to overtreatment reported that urgent care clinics commonly overprescribe antibiotics (in 39% of all visits, patients received antibiotics) and that treatment of subclinical hypothyroidism had no effect on clinical outcomes. Three studies highlighted services that should be questioned, including using opioids for chronic noncancer pain (meta-analysis found no clinically significant benefit), stress ulcer prophylaxis for intensive care unit patients (mortality, 31.1% with pantoprazole vs 30.4% with placebo), and supplemental oxygen for patients with normal oxygen levels (mortality relative risk, 1.21; 95% CI, 1.03–1.43). A policy article found that state medical liability reform was associated with reduced invasive testing for coronary artery disease, including 24% fewer angiograms. The findings suggest that many tests are overused, overtreatment is common, and unnecessary care can lead to patient harm. This review of these 2018 findings aims to inform practitioners who wish to reduce overuse and improve patient care.
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DOI：
10.1056/nejmoa1802670
发表时间：
2018-07-19
期刊：
The New England journal of medicine
影响因子：
--
作者：
Huang DT;Yealy DM;Filbin MR;Brown AM;Chang CH;Doi Y;Donnino MW;Fine J;Fine MJ;Fischer MA;Holst JM;Hou PC;Kellum JA;Khan F;Kurz MC;Lotfipour S;LoVecchio F;Peck-Palmer OM;Pike F;Prunty H;Sherwin RL;Southerland L;Terndrup T;Weissfeld LA;Yabes J;Angus DC;ProACT Investigators
通讯作者：
ProACT Investigators
DOI：
10.1136/bmj.k2357
发表时间：
2018-07-11
期刊：
BMJ (Clinical research ed.)
影响因子：
--
作者：
Khera R;Lu Y;Lu J;Saxena A;Nasir K;Jiang L;Krumholz HM
通讯作者：
Krumholz HM
DOI：
10.1177/1049909118792517
发表时间：
2019-03-01
影响因子：
1.9
作者：
Lambden, Jason P.;Chamberlin, Peter;Prigerson, Holly G.
通讯作者：
Prigerson, Holly G.
影响因子：
2.8
作者：
Chamberlin, Peter;Lambden, Jason;Prigerson, Holly G.
通讯作者：
Prigerson, Holly G.
DOI：
10.1001/jama.2015.13764
发表时间：
2015-11-17
期刊：
JAMA
影响因子：
--
作者：
Desai NR;Bradley SM;Parzynski CS;Nallamothu BK;Chan PS;Spertus JA;Patel MR;Ader J;Soufer A;Krumholz HM;Curtis JP
通讯作者：
Curtis JP