Haslam Alyson, Livingston Catherine, Prasad Vinay
Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon.
School of Medicine, Oregon Health & Science University, Portland, Oregon.
Curr Ther Res Clin Exp. 2020 Feb 22;92:100579. doi: 10.1016/j.curtheres.2020.100579. eCollection 2020.
Primary care physicians are challenged by the need to stay abreast of current research on a wide variety of topics in an environment of time constraints, evolving literature, and misinformation on health topics that are sometimes promulgated to the public.
We sought to identify and discuss common clinical situations encountered in primary care for which medical reversals have occurred.
We recently identified almost 400 medical practices that were used in clinical care before they were tested in well-done randomized controlled trials and subsequently were found to be ineffective or harmful.
We review several of these practices commonly used in family medicine, which include arthroscopy for osteoarthritis of the knee, opioids for common causes of pain, and aspirin and continuous positive airway pressure for the prevention of cardiovascular disease.
Although these practices were implemented because of sound biologic plausibility or encouraging observational data, well done randomized controlled trials have failed to show evidence of effectiveness. These examples raise caution in introducing new clinical interventions into widespread clinical practice without sufficient high-quality evidence demonstrating efficacy.
在时间受限、文献不断演变以及有时向公众传播的健康主题错误信息的环境中，初级保健医生面临着紧跟各种主题当前研究进展的挑战。
我们试图识别并讨论初级保健中出现医学观念逆转的常见临床情况。
我们最近识别出近400种在临床护理中使用的医疗实践，这些实践在经过完善的随机对照试验测试之前被采用，随后被发现无效或有害。
我们回顾了家庭医学中常用的其中几种实践，包括用于膝关节骨关节炎的关节镜检查、用于常见疼痛原因的阿片类药物，以及用于预防心血管疾病的阿司匹林和持续气道正压通气。
尽管这些实践是基于合理的生物学合理性或令人鼓舞的观察数据而实施的，但完善的随机对照试验未能显示出有效性的证据。这些例子警示我们，在没有足够高质量证据证明疗效的情况下，将新的临床干预措施引入广泛的临床实践时要谨慎。
