Resultados de Búsqueda

Choosing Wisely Canada

Burns Canada

It is important to regularly review the indication and dosage of analgesia and anxiolytics (including but not limited to opioids and benzodiazepines) in patients mechanically ventilated for their burn injuries. Higher doses of opioids and benzodiazepines are associated with delays in extubation, an increased risk of systemic infections (including ventilator associated pneumonia), deep vein thrombosis, delirium, and longer hospital stays, which in turn result in deconditioning, and long-term ...

Choosing Wisely Canada

Canadian Fertility and Andrology Society

Multiple studies have demonstrated no improvement in live birth rate or clinical pregnancy rate with steroids, granulocyte colony-stimulating factor (GCSF), leukemia inhibitory factor (LIF) or immunoglobulin (IVIG) in those undergoing IVF or those with a history of recurrent implantation failure (RIF). In women with a history of recurrent pregnancy loss (RPL), there is evidence demonstrating no improvement in live birth rate with IVIG or lymphocyte immune therapy.

Choosing Wisely Canada

Burns Canada

Reliance on opioids as the dominant or only analgesic is associated with harms including not only higher opioid requirements and significant side-effects e.g. nausea, constipation, drowsiness, but also dependence, diversion, and overdose. One should implement a multi-modal analgesic strategy including acetaminophen and NSAIDS if there are no contra-indications. One should also consider medications directed at neuropathic pain (e.g. gabapentin, pregabalin, duloxetine, amitriptyline), as well as ...

Choosing Wisely Canada

Canadian Fertility and Andrology Society

Laser assisted hatching (LAH) is a technique where the zona pellucida is disrupted to improve implantation and therefore live birth rates from embryos created through IVF. Although there may be a benefit to performing LAH on fresh embryos in certain patient populations, the routine use of LAH for all patients undergoing a fresh embryo transfer has not been shown to improve live birth rates.

Choosing Wisely Canada

Canadian Fertility and Andrology Society

Several studies demonstrate that the use of high doses of gonadotropins (approximately 450 units daily or greater) does not result in an increased number of dominant follicles recruited, mature oocytes retrieved, nor good quality embryos produced compared with lower dosing regimens. Furthermore, higher doses of gonadotropins have been associated with an increased risk of ovarian hyperstimulation syndrome (OHSS). Given that there is a greater cost to the patient and potential for harm, with no ...