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Choosing Wisely ® : Things we do for no reason

Choosing Wisely

Cocaine, a potent sympathomimetic agent that potentiates adrenergic tone, increases inotropy and chronotropy through β1‐receptor agonism at the level of the cardiomyocyte, and vasodilation through β2‐receptor agonism in the peripheral vasculature. Vasoconstriction due to activation of α1 receptors in the peripheral vasculature via cocaine-induced increases in circulating catecholamines also occurs, and counteracts β‐mediated smooth muscle relaxation. This combination results in ...

Choosing Wisely ® : Things we do for no reason

Choosing Wisely

Dysphagia is a common complication after acute stroke occurring in 51%-55% of cases. Strokes can cause dysphagia through damage to any of the brain areas involved in swallowing physiology, including the cerebral hemispheres, the cerebellum or the brain stem. The diagnosis of dysphagia is important as it can lead to complications such as pneumonia. For those patients who do not recover before discharge, a decision should be made whether to provide prolonged NG tube feeding or to place a PEG ...

Choosing Wisely ® : Things we do for no reason

Choosing Wisely ®: Things we do for no reason

Opioids are effective for the treatment of pain and dyspnea in dying patients and are recommended as first-line agents by professional guidelines, but dying itself does not automatically require opioid treatment, and many nonpharmacological interventions can increase comfort without involving no medicine. In cases where medication is required, opioid infusions as initial therapy are less effective than opioid boluses. Based on clinical guideline practices, randomized continuous sequential ...

Choosing Wisely ® : Things we do for no reason

Choosing Wisely ®: Things we do for no reason

A systematic review summarizing the efficacy and safety of these agents found no consistent trends in their effects on improving sleep with respect to latency, efficiency, quality, or disruptions. Studies associate benzodiazepines, benzodiazepine receptor agonists, barbiturates, SGAs, and antihistamines with delirium, cognitive impairment, fall-related injuries, and death, especially in the elderly. If AII persists despite nonpharmacological interventions, consider prescribing MRAs as a safer ...

Choosing Wisely ® : Things we do for no reason

Choosing Wisely ®: Things we do for no reason

Fragility hip fractures are a major public health problem. After one year, less than half of patients have recovered their pre-fracture functional status, and up to 30% of them have died. One clinical trial randomised 2127 men and women with fragility hip fractures from 115 clinical centres to annual intravenous (IV) infusions of zoledronic acid (started within 90 days of surgical repair) versus placebo. Patients receiving zoledronic acid had a 35% reduction in the risk of new clinical ...