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It is not recommended prescribing pharmacotherapies as a stand-alone treatment for substance use disorders (SUD), but rather as part of a broader treatment plan that identifies treatment goals, ...
Choosing Wisely Australia
Australasian Chapter of Addiction Medicine
Safe and effective pharmacotherapies exist for the management of substance use disorders (e.g. methadone, buprenorphine, naltrexone for opioid dependence; acamprosate, naltrexone, disulfiram for alcohol dependence; nicotine replacement, varenicline, bupropion for nicotine dependence; and benzodiazepines as part of benzodiazepine withdrawal). However, the vast majority of studies of these pharmacotherapies have either evaluated their effectiveness in combination with psychosocial interventions ...
ver más ... 2021It is not recommended elective withdrawal treatment in the absence of an agreed post-withdrawal treatment plan that addresses substance use and related health problems.
Choosing Wisely Australia
Australasian Chapter of Addiction Medicine
The main aims of withdrawal management are to provide the means for safe withdrawal from a drug of dependence, including alcohol, and to link the patient to relevant ongoing treatment for their Substance Use Disorder (SUD) and health and social conditions. Evidence shows that withdrawal management results in better outcomes, including reduced readmission rates, when a structured post-withdrawal treatment plan is formulated in collaboration with the patient.
ver más ... 2021It is not recommended to use two or more drugs known to increase the risk of bleeding without weighing the possible risks and benefits in pediatrics. These medications include direct oral ...
Choosing Wisely®
Pediatric Hospital Medicine – SHM, AAP, APA
Prescribing more than one of these medications concurrently may result in an enhanced risk of bleeding. This heightened bleeding risk may be mediated through complex pharmacokinetic and/or pharmacodynamic mechanisms. It is well established that the combination of anticoagulants and NSAIDs increase bleeding risk. A combination of warfarin with either single or dual antiplatelet therapy significantly increases the risk of major bleeding by 2- to 4-fold, respectively. The most commonly ...
ver más ... 2021It is not recommended intravenous antibiotics for predetermined durations for hospitalized patients with infections such as pyelonephritis, osteomyelitis, and complicated pneumonia. Consider early ...
Choosing Wisely®
Pediatric Hospital Medicine – SHM, AAP, APA
Recent publications have demonstrated that strategies for early transition to oral antibiotics achieve equal or better outcomes for common inpatient infections and are safer than prolonged intravenous antibiotics in children. The use of intravenous lines such as peripherally inserted central catheters, which are often necessary for prolonged intravenous antibiotics, can lead to complications such as thrombosis or line infections. Antibiotic courses with predetermined durations are often not ...
ver más ... 2021It is not recommended continue hospitalization in well-appearing febrile infants once bacterial cultures (i.e. blood, cerebrospinal, and/or urine) have been confirmed negative for 24–36 hours, if ...
Choosing Wisely®
Pediatric Hospital Medicine – SHM, AAP, APA
Routinely continuing hospitalization beyond 24–36 hours of confirmed negative bacterial cultures for well-appearing infants admitted for concern of serious bacterial infection does not improve clinical outcomes. Blood culture yield is highest in the first 12–36 hours after incubation with multiple studies demonstrating >90% of pathogen cultures being positive by 24 hours. If adequate outpatient follow-up can be assured, discharging well-appearing febrile infants at 24–36 hours if cultures ...
ver más ... 2021