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Choosing Wisely Canada

Canadian Fertility and Andrology Society

Preimplantation genetic testing for aneuploidy (PGT-A) was developed to help select the best embryos for transfer in an in vitro fertilization (IVF) cycle by screening out aneuploidy. However, there is no clear improvement in cumulative live birth rate compared with IVF alone. PGT-A is expensive, carries a risk of misdiagnosis, and there is no long-term data reported on childhood outcomes. PGT-A should not be performed routinely without an indication and patients should be counselled on the ...

Choosing Wisely Canada

Burns Canada

Most wound swabs in the context of a burn injury will yield bacterial growth. These organisms may be commensal organisms not responsible for wound infection or sepsis, and do not warrant therapy. The use of systemic agents predisposes to antimicrobial resistance, is expensive, and may also expose patients to unnecessary side-effects. Burn wound swabs should form part of standardized admission surveillance programs for resistant organisms such as MRSA.

Choosing Wisely Canada

Canadian Association of General Surgeons

The diagnosis of most inguinal hernias can be made with a focused patient history and physical examination. Routine ultrasounds add little value to the diagnosis and management of clinically evident inguinal hernias and can result in treatment delay. These investigations should therefore not be performed where there is a clearly palpable abdominal wall defect and should instead be limited to use in the evaluation of occult inguinal hernias.

Choosing Wisely Canada

Burns Canada

The available evidence does not support the routine use of early systemic antibiotic prophylaxis in the management of patients with acute burn injuries. In addition to exposing patients to side-effects, antibiotic use without indication encourages the development of resistance, thus reducing treatment options during the patient’s hospital course. Topical antimicrobial dressings are the standard of care for these patients.

Choosing Wisely Canada

Burns Canada

Evidence supporting the routine use of hydroxycobalamin is weak and may be associated with the development of renal impairment. Hydroxycobalamin may be administered in the burn centre in the setting of a severe inhalation injury and uncorrected worsening metabolic acidaemia. Patients with a strong clinical picture of severe inhalation injury who require prolonged transport to a burn centre may be the exception to this rule.