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Choosing Wisely Canada

Canadian Rheumatology Association

A palliative approach to care alongside disease-specific treatment should be part of the continuum of care for patients with advanced rheumatic disease toward the end of life. This approach aims to improve quality of life for patients with life-limiting illnesses, through the prevention and relief of suffering, the control of symptoms, and the management of physical, psychosocial and spiritual distress. Such an approach is supported by a growing body of evidence that demonstrates improved ...

Choosing Wisely®

American Occupational Therapy Association

Las intervenciones diseñadas únicamente para integrar los reflejos retenidos no promueven la participación en la ocupación, y aunque pueden observarse en clientes con dificultades en el desempeño ocupacional, la presencia de reflejos retenidos no equivale necesariamente a un deterioro funcional. Si se considera la posibilidad de intervenir con técnicas de integración de reflejos (es decir, técnicas diseñadas para integrar o inhibir los reflejos motores primarios retenidos más allá de ...

Choosing Wisely Canada

Canadian Pediatric Neurosurgery Study Group

Chiari I malformation, defined as cerebellar tonsillar herniation greater than or equal to 5mm below the foramen magnum on MRI brain, is a frequent incidental finding in children, with an estimated prevalence of 1 to 3%. The vast majority of children with incidentally discovered, asymptomatic Chiari I malformations without syringomyelia have no clinically significant progression of tonsillar descent on routine follow-up, and symptom development is often unassociated with radiographic change. ...

Choosing Wisely Canada

Canadian Neurological Society

Butalbital, butorphanol, and ergotamine are not adequate abortive or preventative treatments for patients who suffer with migraines. Butalbital and butorphanol are barbiturate containing medications which carry the risks of sedation, intoxication, dependence, abuse potential, severe withdrawal, and substance use disorders. The risk of medication overuse headache with these medications is also significant. These medications are only helpful in refractory cases of migraines as a last resort. ...

Choosing Wisely®

American Occupational Therapy Association

Standard shoulder slings immobilize the upper extremity in a flexor pattern (i.e., a position of elbow flexion, and shoulder adduction and internal rotation). Utilizing a sling that places a person’s hemiplegic arm in this position for extended periods of time increases the risk of contractures and pain, and limits active use of the extremity, thereby decreasing opportunities for neuroplastic changes that support an organic increase in function. Education should be provided to clients and ...