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It is not recommended to delay conversations about wishes and goals with patients who have serious or progressive chronic respiratory illness, such as COPD, IPF, PH, or CF. Unnecessary and ...
Choosing Wisely Canada
Canadian Thoracic Society
Supporting patients with serious or progressive respiratory illness to identify and document their values and treatment wishes is an important, but often neglected, intervention. While these patients often experience complex disease trajectories that make accurate prognostication challenging, these discussions can ensure future care is aligned with patients’ preferences.
ver más ... 2021It is not recommended to order neuroimaging or EEG in asymptomatic patients in the emergency department with syncope and a normal neurological evaluation.
Choosing Wisely Canada
Canadian Neurological Society
Syncope, and pre-syncope with observed convulsions are very common and frequently investigated in the emergency department. Typical syncope with a normal examination requires minimal investigation. Neuroimaging and EEG will not help in determining the etiology or management of patients with typical syncope in the absence of focal neurologic symptoms or findings on examination.
ver más ... 2021It is not recommended to use a test-based requirement for return to work clearance following COVID-19 when time-based strategies are appropriate.
Choosing Wisely Canada
Occupational Medicine Specialists of Canada
Reverse Transcription-Polymerase Chain Reaction (RT-PCR) amplification tests remain positive in some people’s respiratory samples after recovery from coronavirus disease 2019 (COVID-19) infection with prolonged viral RNA shedding demonstrated without direct evidence of there being viable virus capable of replicating or causing infection. Test-based strategies relying on the absence of viral fragments, such as RNA or antigen, for return to work clearance may therefore inappropriately delay ...
ver más ... 2021Is not recommended to perform routine prothrombin time (PT) and partial thromboplastin time (PTT, APTT) pre-operative screens on asymptomatic patients, use instead a history-based bleeding assessment ...
Choosing Wisely®
American Society for Clinical Laboratory Science
The 1989 Medical Necessity Project of the Blue Cross and Blue Shield Association endorsed by the American College of Physicians found that at least 70% of PT and PTT tests were not clinically indicated. Subsequently, nine observational studies, including three prospective trials, reported that PT and PTT positive predictive values for bleeding complications ranged from 0.03 to 0.22, whereas computed 95% confidence intervals for each assay generates a 2.5% false positive rate. A review of 27,737 ...
ver más ... 2021It is not recommended to choose opioids or cannabinoids as the first choice of treatment for neuropathic pain.
Choosing Wisely Canada
Canadian Neurological Society
Opioids and cannabinoids have weak or inconclusive evidence in effective treatment of neuropathic pain. The well documented risks of opioid and cannabinoids include nausea, sleepiness, impairment, dependence, and development of substance use disorders. With impairment comes further risks to oneself and others in altered judgement in the workplace or while operating a vehicle. Opioids come with an additional risk of decreased respiratory drive and fatality with overdose. Neuropathic pain can be ...
ver más ... 2021