Resultados de Búsqueda

Choosing Wisely®

American Society for Clinical Laboratory Science

For long it was thought that elevated homocysteine was associated with cardiovascular diseases. That in turn could lead to coronary artery disease, heart attacks, strokes, clots in veins causing deep vein thrombosis (DVT) and pulmonary embolism (PE), and pregnancy complications among others. But in 2010 the American Heart Association declared that elevated homocysteine levels were not considered to be a major risk factor for cardiovascular disease. Subsequently, in 2013, the American College of ...

Choosing Wisely Canada

Society of Obstetricians and Gynaecologists of Canada

The likelihood of preterm delivery and also the gestational age need to be carefully considered when contemplating the use of antenatal corticosteroid therapy among pregnant women. The efficacy of such therapy is highest when the course is given 24 hours to 7 days prior to delivery. Administration more than 7 days before delivery leads to reduced benefit and potentially unnecessary adverse effects . Trials enrolling pregnant women from 24 + 0 to 34 + 6 weeks gestation at high risk of preterm ...

Choosing Wisely Canada

Canadian Neurological Society

Valproic acid is teratogenic for a developing fetus and should be avoided. Valproic acid increases the risk of diminished IQ as well as major congenital malformations including neural tube defects and cardiovascular abnormalities for a developing fetus. If valproic acid treatment is deemed necessary, patients should be counselled regarding contraception and the risks of conception. In this case, the lowest effective dose should be used.

Choosing Wisely®

American Society for Clinical Laboratory Science

Thrombophilia has numerous causes, including protein S deficiency, of which there are 3 recognized types. Type I and type III are quantitative defects while type II is a qualitative defect. Type II is extremely rare and is not considered a risk factor for thrombophilia. While functional protein S activity is commonly measured to detect protein S deficiency, there are problems with this test. It is a clot-based assay and has a large coefficient of variation; the test is affected by patients who ...

Choosing Wisely Canada

Canadian Neurological Society

Typically, epilepsy patients have brain imaging at the time of diagnosis to investigate for a structural cause for seizures. Seizures in these patients are unlikely a result of new structural changes. Neuroimaging in can be considered in patients with longstanding epilepsy without prior imaging studies, or in patients who are candidates for neurosurgery with seizures refractory to medical management.