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It is not recommended to prescribe opioids for management of chronic rheumatic disease before optimizing the use of non-opioid approaches to pain management.
Choosing Wisely Canada
Canadian Rheumatology Association
Opioids in chronic non-cancer pain are associated with substantial risks. Optimize non-opioid pharmacotherapy and non-pharmacologic therapy. Opioids are not superior to non-opioid medications for pain-related function over 12 months in moderate to severe hip or knee osteoarthritis, or mechanical back pain. Opioids should only be prescribed by physicians skilled in their use.
ver más ... 2021It is not recommended to order a standard-dose CT scan to initially investigate macrocephaly. Instead, ultrasound, MRI or ultra-low-dose CT should be ordered.
Choosing Wisely Canada
Canadian Pediatric Neurosurgery Study Group
A common pediatric neurosurgery referral is a young child with a rapidly increasing head circumference crossing percentiles. The differential diagnosis is broad and includes benign expansion of the subarachnoid spaces (BESS), subdural collections, hydrocephalus, and neoplasm. When the fontanelle is open, the etiology can usually be diagnosed on head ultrasound, and this should therefore be the initial screening test of choice. In the absence of an open fontanelle, or if there are other signs ...
ver más ... 2021It is not recommended to use opioids for treatment of migraines.
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Canadian Neurological Society
Opioids are not adequate for pain control for patients with migraines. The risk for harm, including impairment, dependence, tolerance, medication overuse headaches, and opioid use disorder with opioids is greater than the documented benefit. Additionally, opioids may worsen nausea and vomiting associated with the migraine. Prescription opioids for migraines would have minimal to no benefit with the excess of risk, and contribute to the opioid crisis.
ver más ... 2021Is not recommended to provide ambulation or gait training interventions that do not directly link to functional mobility.
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American Occupational Therapy Association
Occupational therapy practice requires consideration of contextual factors that affect a person’s ability to participate in meaningful occupations. Gait training and ambulation interventions do not necessarily consider the context of performing everyday activities. While occupational therapists can assess underlying performance skills for ambulation and gait and utilize related interventions, they must address functional mobility by considering the context in order to implement effective, ...
ver más ... 2021It is not recommended to order CT head scans in adults and children who have suffered minor head injuries (unless positive for a validated head injury clinical decision rule).
Choosing Wisely Canada
Canadian Neurological Society
Head injuries in children and adults are common presentations to the emergency department. Minor head injury is characterized by: Glasgow Coma Scale (GCS) 13-15, associated with either witnessed loss of consciousness, definite amnesia, or witnessed disorientation. Most adults and children with minor head injuries do not suffer from serious brain injuries that require hospitalization or surgery. CT head scans performed on patients without signs of significant injuries can expose patients to ...
ver más ... 2021