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Is not recommended to use viscoelastic testing to determine blood product transfusions in trauma patient resuscitation without an established, institutional treatment algorithm in place.
Choosing Wisely®
American Society for Clinical Laboratory Science
Currently, many trauma patients presenting to emergency departments are resuscitated through blood product transfusions guided by conventional coagulation tests (CCTs) only. Acute care organizations that utilize viscoelastic testing (VET) in conjunction with CCTs do not commonly have treatment algorithms in place to guide blood transfusions in trauma patients, which can result in the overuse of blood products. When assessing the number of hospitals that have institutional massive transfusion ...
ver más ... 2021It is not recommended to perform a cesarean delivery for the sole indication of lack of labor progress in the latent phase of labor for a woman at term with a singleton fetus and cephalic ...
Choosing Wisely Canada
Society of Obstetricians and Gynaecologists of Canada
Women who do not make progress in cervical dilatation at less than 4 cm can be managed expectantly, with analgesia and rest as needed. They generally have good outcomes and can often deliver vaginally with no further complications, similar to women who did not have a prolongation of the latent phase of labour. According to the of Obstetricians and Gynaecologists of Canada (SOGC) Clinical Practice Guideline on Management of Labour, “Dystocia cannot be diagnosed prior to the onset of labour ...
ver más ... 2021Is not recommended to use serum cortisol levels as initial screening for adrenal hyperfunction [Cushing syndrome], instead consider superior strategies provided in the justification.
Choosing Wisely®
American Society for Clinical Laboratory Science
Serum cortisol levels do not provide high-end diagnostic accuracy or sensitivity when used as an initial diagnostic test. Late night salivary cortisol samples employing an approved collection device, 24-hour urine free cortisol [UFC], or a 1 mg overnight dexamethasone suppression test [DST] should be used as an initial test. These tests have a high diagnostic accuracy for Cushing syndrome [CS]. Multiple screening tests may need to be performed based on the variability of hypercortisolism in CS. ...
ver más ... 2021It is not recommended to remove ovaries in premenopausal women without strong clinical indications.
Choosing Wisely Canada
Society of Obstetricians and Gynaecologists of Canada
Large US population-based databases have estimated the rate of bilateral salpingo-oophorectomy (BSO) at the time of hysterectomy for benign indications to be 46.4%. When stratified by age, the rates of oophorectomy in women 45-49 years is approximately 60%, and in women >55 years is 65-75%. Studies have shown increase in all-cause mortality, coronary heart disease and cardiovascular death in women with BSO <50 years. These risks may be modified with hormone therapy. BSO has also been shown to ...
ver más ... 2021Is not recommended to proceed with non-emergent major surgery in neonates, infants and children until anemia is evaluated and treated.
Choosing Wisely®
Society for the Advancement of Patient Blood Management
Anemia is a global health problem with an incidence of up to 25% in neonates, infants and children. An independent association between preoperative anemia and postoperative morbidity and mortality has been reported. Expert consensus guidelines recommend screening 3 to 6 weeks before majo elective surgery. Targeted preventative and therapeutic strategies, which may include iron supplementation, to improve the hematologic status of anemic patients prior to surgery could reduce blood transfusions, ...
ver más ... 2021