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It is not recommended to use intra-articular corticosteroid injections as a treatment approach for a large number of joints or joints that have been injected multiple times.
Choosing Wisely Canada
Canadian Rheumatology Association
Pediatric patients with juvenile idiopathic arthritis (JIA) often benefit from treatment with intra-articular corticosteroid injections, especially when arthritis is impacting activities of daily living. However, in patients with polyarticular JIA (≥5 affected joints) the probability of a short-lived or poor response to corticosteroid injections is increased when compared to those with oligoarticular JIA (≤4 affected joints). Lack of concomitant initiation of a disease modifying ...
ver más ... 2021It is not recommended to transfuse older RBC units (>7 days) in infants <10 kg or < 1 year of age requiring massive transfusions to prevent hyperkalemic cardiac arrest.
Choosing Wisely®
Society for the Advancement of patient blood management
Transfusion-associated hyperkalemia resulting in cardiac arrest (TAHCA) has been recognized as a complication of massive RBC transfusion in children. During storage, potassium in the extracellular fluid of RBC units stored in additive solutions increases linearly over time. Transfusion of older RBC units (≥7 days) should be avoided when large volume/ massive transfusions are expected in neonates and children, such as in craniosynostosis and spinal surgeries, neonatal CPB prime, and ...
ver más ... 2021It is recommended to use virtual care to complement in-person visits in order to meet the needs of residents in long-term care during the COVID-19 pandemic.
Choosing Wisely Canada
Canadian Society for Long Term Care Medicine
To reduce the potential of serious outbreaks in long-term care during COVID-19, physicians are encouraged to practice virtual medicine, where appropriate. To be effective, physicians and senior leadership, must strive for excellent communications and timely access to physicians. Studies have shown that the use of telemedicine in caring for nursing home residents can facilitate better patient care and overall cost savings through reducing unnecessary hospital transfers to the emergency ...
ver más ... 2021It is not recommended to order Lyme disease serology as an explanation for musculoskeletal symptoms without an exposure history and exam findings.
Choosing Wisely Canada
Canadian Rheumatology Association
Lyme disease is most likely to occur if an individual resides in or visits an endemic area. The most common musculoskeletal (MSK) manifestation of Lyme disease is persistent or intermittent arthritis in at least one joint (typically the knee) which develops within weeks to months after a tick bite. Chronic diffuse arthralgias, myalgias or fibromyalgia alone are not criteria for MSK Lyme disease. Testing for Lyme disease should be limited to children with characteristic clinical signs and risk ...
ver más ... 2021It is not recommended to depend on standard laboratory values for transfusion decisions; consideration of the patient’s clinical status is requisite
Choosing Wisely®
Society for the Advancement of Patient Blood Management (SABM)
Laboratory studies may not accurately portray the individual’s hemostatic status, bleeding risk or need for transfusion; laboratory studies must be assessed in the context of the patient’s overall clinical status. Additional platelet function and viscoelastic testing should be performed to guide blood product transfusions in children with (or at risk for) moderate to severe bleeding. Pharmacologic modalities (i.e. antifibrinolytics, topical hemostatic agents) should be utilized as ...
ver más ... 2021