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It is not recommended the use of physical restraints as the first choice to prevent self-extubation or removal of lines or tubes with critically ill patients.
Choosing Wisely Canada
Canadian Nurses Association, Canadian Association of Critical Care Nurses
The intention to use physical restraints to prevent self-extubation or accidental removal of lines or tubes is often misguided. In fact, some research has found restraints have the potential to cause harm to critically ill patients, including complications but not limited to unplanned extubation, increased risk for delirium, and prolonged recovery. The use of physical restraints in ICU patients in Canada is common and significantly higher comparable to some European countries. Guidelines ...
ver más ... 2021It is not recommended to initiate therapy with opioids for patients with chronic non-cancer pain unless non-opioid pharmacotherapy and other non-pharmacological options have been optimized.
Choosing Wisely Canada
Canadian Society of Internal Medicine
Several non-opioid therapies (including both drug and non-drug alternatives) may achieve a similar magnitude of improvement in pain and function more safely without the potentially serious side effects of opioid therapy (e.g. harms related to dependence, addiction and overdose).
ver más ... 2021It is not recommended to order rheumatoid factor or anti-citrullinated protein antibodies in patients with arthralgia but no arthritis on exam.
Choosing Wisely Canada
Canadian Rheumatology Association
In children, the vast majority of musculoskeletal (MSK) pain is non-inflammatory (97%) and is rarely secondary to a rheumatic disease. For patients with arthralgia (joint pain) but no arthritis on physical exam (defined as presence of joint effusion or ≥2 of warmth, tenderness, stress pain, reduced range of motion), testing rheumatoid factor (RF) or anti-cyclic citrullinated peptide (anti-CCP) is not clinically useful and has low diagnostic utility. For example, a positive RF may result from ...
ver más ... 2021It is not recommended to order HLA-B27 unless spondyloarthropathy is suspected based on clinical signs or symptoms.
Choosing Wisely Canada
Canadian Rheumatology Association
Back pain is a common symptom relative to the incidence of spondyloarthropathy (SpA) in children. In addition, the prevalence of HLA-B27 is 2-8% in the general population, and individuals with a positive HLA-B27 have a low probability of developing SpA. As such, HLA-B27 testing is not useful as a single diagnostic test in a patient with low back pain without specific signs or symptoms of SpA (e.g., inflammatory back pain, peripheral arthritis, enthesitis, or acute anterior uveitis) or ...
ver más ... 2021It is not recommended to administer benzodiazepines to treat symptoms of delirium.
Choosing Wisely Canada
Canadian Nurses Association, Canadian Association of Critical Care Nurses
The treatment of delirium is multifactorial, including environmental stimulation, ongoing mobilization and family presence. Guidelines recommend against using benzodiazepines for sedation, unless otherwise indicated (e.g., withdrawal related to alcohol or benzodiazepine use). The inappropriate administration of benzodiazepines may harm a critically ill patient by inadvertently increasing the incidence of delirium or the length of stay in an ICU. Nonpharmacologic strategies should be used, along ...
ver más ... 2021