How to Identify Low Value and Ineffective Medical Care

Objective: List several methods to identify low-value and ineffective medical care

Evidence-based de-implementation for contradicted, unproven, and aspiring healthcare practices

Abandoning ineffective medical practices and mitigating the risks of untested practices are important for improving patient health and containing healthcare costs. Historically, this process has relied on the evidence base, societal values, cultural tensions, and political sway, but not necessarily in that order. We propose a conceptual framework to guide and prioritize this process, 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

US News and World Report Cancer Hospital Rankings: Do They Reflect Measures of Research Productivity?

Context: Prior research has faulted the US News and World Report hospital specialty rankings for excessive reliance on reputation, a subjective measure of a hospital's performance.Objective: To determine whether and to what extent reputation correlates with objective measures of research productivity among cancer hospitals.Design: A retrospective observational study.Setting: Automated search of NIH Reporter, BioEntrez, BioMedline and Clinicaltrials.gov databases.Participants: The 50 highest ranked cancer hospitals in 2013's US News and World Report Rankings.Exposure: We ascertained the number of NCI funded grants, and the cumulative funds received by each cancer center. Additionally, we identified the number of phase I, phase II, and phase III studies published and indexed in MEDLINE, and registered at clinicaltrials.gov. All counts were over the preceding 5 years. For published articles, we summed the impact factor of the journals in which they appeared. Trials were attributed to centers on the basis of the affiliation of the lead author or study principal investigator.Main Outcome: Correlation coefficients from simple and multiple linear regressions for measures of research productivity and a center's reputation.Results: All measures of research productivity demonstrated robust correlation with reputation (mean r-squared  = 0.65, median r-squared = 0.68, minimum r-squared = .41, maximum r-squared = 0.80). A multivariable model showed that 93% of the variation in reputation is explained by objective measures.Conclusion: Contrary to prior criticism, the majority of reputation, used in US News and World Rankings, can be explained by objective measures of research productivity among cancer hospitals.</p

Effect of Hybridization of Glass/kevlar Fiber on Mechanical Properties of Bast Reinforced Polymer Composites: A Review

Natural fibres are gaining more and more interest as reinforcing materials for polymer composite due to their environmental and economical benefits.  Bast fibers is a prominent reinforcement for use in polymeric materials because of its low specific weight and cost, eco-friendly and abundantly available in nature. Several authors manifest the cellulosic fibers based polymeric composites as advantageously used in automobile industries and structural applications, but certain problems have been associated during usage of such fiber such as high water/mosture-uptake and low strength than inorganic fibers. These problems have been reduced to a major extent with enhancements in mechanical properties by the researchers through hybridization of these natural fiber based composites with synthetic fiber (glass/Kevlar). In the present article, we reviewed the effect of hybridization of glass/Kevlar synthetic fibers on mechanical properties of bast fiber (jute, hemp, kenaf, flax) reinforced polymer composites

Synthesis and characterization of 5-aryl-1,3,4-oxadiazole-2(3h)thione derivatives

1,3,4-oxadiazoles represent a class of heterocyclic five membered compounds it contain two nitrogen and one oxygen of great importance in Pharmaceutical chemistry. This nucleus show four isomeric forms 1,2,4-oxadiazole,1,3,4-oxadiazole, 1,2,5-oxadiazole, and 1,2,3-oxadiazole. This nucleus has various biological activity such as antioxidant, antimicrobial, antifungal, antitumor, antidepressant, anticancer, analgesic etc.  have been reported. A series of 1,3,4-oxadiazoles-2(3H)thione derivative has been synthesized in four steps and the derivative were characterized by FTIR spectral analysis. This article explain the different biological activities associated with 1,3,4-oxadiazole five membered ring are useful for researchers across the world working on this nucleus

Evidence for Community Face Masking to Limit the Spread of SARS-CoV-2: A Critical Review

The use of facemasks in community settings has become an accepted public policy response to decrease disease transmission during the COVID-19 pandemic. Yet evidence of facemask efficacy is based primarily on observational studies that are subject to confounding and on mechanistic studies that rely on surrogate endpoints (such as droplet dispersion) as proxies for disease transmission. The available clinical evidence of facemask efficacy is of low quality and the best available clinical evidence has mostly failed to show efficacy, with fourteen of sixteen identified randomized controlled trials comparing face masks to no mask controls failing to find statistically significant benefit in the intent-to-treat populations. Of sixteen quantitative meta- analyses, eight were equivocal or critical as to whether evidence supports a public recommendation of masks, and the remaining eight supported a public mask intervention on limited evidence primarily on the basis of the precautionary principle. Although weak evidence should not preclude precautionary actions in the face of unprecedented events such as the COVID-19 pandemic, ethical principles require that the strength of the evidence and best estimates of amount of benefit be truthfully communicated to the public

Multiple Comparisons in Variation of Care Research

Research in hospital variation is important and currently very popular. However, due to the methods employed in such studies—namely, the retrospective mining of large datasets and the use of several alternative variation groupings—some results may be spurious. In this commentary, we perform an empirical analysis of the 50 most highly cited and the 50 most recent papers focusing on variation in medical care. Across these studies, we identify at least 13 unique groupings and could find no single instance where a medical practice was found not to vary. We go on to discuss one example of variation—statin use—in more detail to elucidate the tensions that these studies often create. Together, these results suggest that multiple hypothesis testing is a concern for variation research. Finally, we outline strategies to mitigate this concern. RÉSUMÉ La recherche sur la variation hospitalière est importante et actuellement très populaire. Toutefois, en raison des méthodes employées dans de telles études—notamment, l’extraction rétrospective de grands ensembles de données et l’utilisation de plusieurs groupe- ments de variation alternatifs—certains résultats peuvent être fautifs. Dans ce commentaire, nous effectuons une analyse empirique des 50 articles les plus citées et des 50 articles les plus récents se concentrant sur la variation dans les soins médicaux. Dans ces études, nous identifions au moins 13 groupements uniques, et ne pouvions trouver aucun cas où une pratique médicale ne variait pas. Nous discutons ensuite d’un exemple de variation—dans l’utilisation de statines—en plus de détails afin d’élucider les tensions que ces études suscitent souvent. Collectivement, ces résultats suggèrent que la mise à l’essai de multiples hypothèses est une préoccupation lors de la recherche sur la variation. Finalement, nous décrivons des stratégies pour atténuer cette préoccupation.