Article Figures & Tables
Figures
- Figure 1
Flow chart showing selection of articles on medical practices analogized to parachutes.
- Figure 2
Outcome of interest for medical practices analogized to parachutes.
Tables
- Table 1: Medical practices analogized to parachutes that have been tested with a randomized controlled trial(s)
Author Claim RCT Clinical outcome of medical practice Trial outcome Magnitude of benefit/outcome met in trial Falchook,12 2015 Nivolumab for metastatic melanoma has so impressive a response rate and progression-free survival that, akin to a parachute, examining overall survival is not necessary Nivolumab versus chemotherapy in patients with advanced melanoma who progressed after anti-CTLA-4 treatment (CheckMate 037): a randomised, controlled, open-label, phase 3 trial13 [nivolumab was superior to decarbazine in CheckMate 6614 (and choice of comparator seemed a straw man, given year trial was performed)] Reduction in mortality Supported practice 1-yr overall survival rate increased from 42.1% to 72.9%; ARR 30.8%, NNT 3 Schaan et al.,15 2015 Insulin analogues are superior to regular human insulin for achieving glycemic control in type 1 diabetes Several, including large meta-analyses such as Systematic review and meta-analysis of short-acting insulin analogues in patients with diabetes mellitus16 and Long-acting insulin analogues vs. NPH human insulin in type 1 diabetes. A meta-analysis17 Reduction in diabetes-related events (cardiovascular/renal/ocular/neurologic) Mixed - Montresor et al.,18 2015 Empirical deworming therapy of children in endemic areas has clinical benefit Cochrane reviews of multiple RCTs, including Deworming drugs for soil-transmitted intestinal worms in children: effects on nutritional indicators, haemoglobin, and school performance19 Clearance of parasites Refuted claim - Luft et al.,20 2014 Stenting for renal artery stenosis benefits some patients so greatly that it is a parachute Stenting and medical therapy for atherosclerotic renal-artery stenosis21 Reduction in cardiovascular events Refuted claim - White,22 2011 Stenting for renal artery stenosis benefits some patients so greatly that it is a parachute Stenting and medical therapy for atherosclerotic renal-artery stenosis21 Reduction in cardiovascular events Refuted claim - Bender et al.,23 2015 Simulation-based training for medical personnel obviously improves patient outcomes in critical care medicine Multiple, including Simulation improves procedural protocol adherence during central venous catheter placement: a randomized controlled trial24 Reduction in mortality Mixed - Lighthall et al.,25 2007 Simulation-based training for medical personnel obviously improves patient outcomes in critical care medicine Multiple, including Simulation-based training of internal medicine residents in advanced cardiac life support protocols: a randomized trial26 Reduction in mortality Mixed - Cefalu et al.,27 2015 Recognition and treatment of prediabetes leads to improved patient outcomes Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin28 Reduction in diabetes-related events (cardiovascular/renal/ocular/neurologic) Supported practice Cumulative incidence of diabetes at 3 yr decreased from 28.9% to 14.4%; ARR 14%, NNT 7 Scheen et al.,29 2014 Treating diabetes with agents that lower blood glucose will invariably lead to improved cardiovascular outcomes Action to Control Cardiovascular Risk in Diabetes,30 UK Prospective Diabetes Study,31 Veterans Affairs Diabetes Trial32 Reduction in cardiovascular events Refuted claim - Gleicher et al.,33 2016 Most of current in vitro fertilization use and application is so obviously beneficial at conceiving children it does not require randomized trials A multicentre randomized controlled trial of expectant management versus IVF in women with fallopian tube patency34 Increased rates of live birth Supported practice Live birth rate improved from 1% to 29%, ARR 28%, NNT 3 Bush,35 2008 The use of pancreatic enzyme replacement for patients with cystic fibrosis and pancreatic insufficiency has clear clinical benefit Efficacy and safety of Pancreaze® for treatment of exocrine pancreatic insufficiency due to cystic fibrosis36 Weight gain/absorption/nutrition Supported practice Measures of fat absorption improved, but ARR and NNT could not be calculated Mattei,37 2013 Intracranial pressure monitoring for severe traumatic brain injury provides useful information that improves outcomes A trial of intracranial-pressure monitoring in traumatic brain injury38 Reduction in mortality Refuted claim - Eljamel,39 2010 Photodynamic therapy improves outcomes in glioblastoma multiform ALA and malignant glioma: fluorescence-guided resection and photodynamic treatment40 Reduction in mortality Supported practice Progression-free survival at 6 mo increased from 21% to 41%; ARR 20%, NNT 5 Primrose et al.,41 2010 Metastasectomy improves outcomes in pulmonary colorectal cancer Pulmonary metastasectomy in colorectal cancer: the PulMiCC trial42 Reduction in mortality Ongoing - Schellinger et al.,43 2006 Intra-arterial thrombolysis improves clinical outcomes in acute basilar artery thrombosis Results of a multicentre, randomised controlled trial of intra-arterial urokinase in the treatment of acute posterior circulation ischaemic stroke44 Reduction in mortality Halted (low recruitment) - Hofman et al.,45 2014 Peptide receptor radionuclide therapy for neuroendocrine tumours is of clear benefit NETTER-1 phase III in patients with midgut neuroendocrine tumors treated with 177Lu-DOTATATE: efficacy and safety results46 Reduction in mortality Supported practice Overall mortality rate decreased from 23% to 12%; ARR 11%, NNT 9 Friedman et al.,47 2006 Hyperbaric oxygen therapy improves skin graft healing and survival Influence of hyperbaric oxygen on the survival of split skin grafts,48 Changes in arterial flow after flap grafting under various tensions49 Rates of skin graft rejection Mixed - Yehai,50 2006 Use of ultrasonographic guidance during embryo transfer in in vitro fertilization is obviously beneficial Ultrasound-guided embryo transfer: a prospective randomized controlled trial51 Increased rates of live birth Mixed - Baca et al.,52 2011 The benefit of hyperthermic intraperitoneal chemotherapy in peritoneal mesothelioma is so obvious that it is akin to a parachute Surgery plus intraoperative peritoneal hyperthermic chemotherapy (IPHC) to treat peritoneal carcinomatosis53 Reduction in mortality Completed, no results published - McCullough, 201454 The use of sucralfate for oral mucositis is of such great benefit that it should be considered level 1A evidence based on observational studies Magic mouthwash plus sucralfate versus benzydamine hydrochloride for the treatment of radiation-induced mucositis55 Decreased mucositis pain/discomfort Ongoing - Sharif et al.,56 2010 Repair of defective dental restorations with composite restoration should be considered over replacement strategies, despite lack of RCT data Study of the success and survival of dental composite restorations being repaired instead of being replaced57 Dental outcomes Halted (low recruitment) - Cannon et al.,58 2005 Use of hygiene education interventions for the prevention of cytomegalovirus transmission is beneficial, akin to a parachute Clinical trial of behavioural modification to prevent congenital cytomegalovirus59 Reduced infection transmission Completed, no results published - Note: ALA = 5-aminolevulinic acid, ARR = absolute risk reduction, IVF = in vitro fertilization, NNT = number needed to treat, NPH = neutral protamine Hagedorn, RCT = randomized controlled trial.
- Table 2: Medical practices analogized to parachutes for which no ongoing or unpublished randomized controlled trial was identified
Author Claim Clinical outcome of medical practice Practice could/should be tested by RCT Diogo et al.,60 2015 Having an intensive care unit in a hospital is of benefit Reduction in mortality No Bryce et al.,61 2015 Positive results from an observational trial of nasal photodisinfection and chlorhexidine wipes for prevention of skin/soft-tissue infections are sufficient for implementation of practice Reduced skin infections Could be subject to RCT Shah,62 2015 Endoscopic decompression of symptomatic cystic duct obstruction is beneficial, akin to a parachute Reduction of symptoms in symptomatic gallbladder disease - Mhyre et al.,63 2009 Emergency airway management is a form of "parachute medicine" Reduction in mortality - Tsui,64 2014 The benefit of cerebrospinal fluid lavage following intrathecal injection of excess or wrong drugs is so beneficial that it is akin to a parachute Reduction in mortality - Seto et al.,65 2015 The use of covered stents for coronary artery perforation is beneficial, despite lack of RCT data Reduction in mortality - Nelson et al.,66 2014 Surgical management of acute epidural hematoma is beneficial, despite lack of RCT data Reduction in mortality - Ignatowski et al.,67 2014 Perispinal etanercept in the setting of poststroke neurologic dysfunction has therapeutic benefit, despite lack of RCT data Reduction of neurologic and cognitive dysfunction Could be subject to RCT Evers,68 2013 In vitro fertilization is effective in couples without a chance of spontaneous pregnancy, akin to a parachute Increased rates of live birth - Harbarth,69 2013 Requiring short fingernails among providers will decrease rates of infection transmission Reduction in infection transmission Could be subject to RCT North et al.,70 2014 Use of new adhesive for spinal cord stimulator implantation was effective and can be safely implemented under guise of "mechanism-based medicine," akin to a parachute Reduced stimulator lead migration Could be subject to RCT Landucci,71 2004 Mechanical ventilation in lung injury is beneficial Reduction in mortality - Sennerby,72 2000 Osseointegrated dental implants are beneficial for treating total or partial edentulism, akin to a parachute Dental outcomes - Note: RCT = randomized controlled trial.
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