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Choosing Wisely Canada

Canadian Society of Clinical Chemists

A directed clinical care plan and laboratory information for ordering urine drug testing are needed to support clinical management. Immunoassays are known for their false positives that can mislead patient treatment. Mass spectrometry testing offers the most reliable and complete results. Physicians considering drug testing should consider consulting with the laboratory for advice on choosing the best testing methodology available and help interpreting the results.

Choosing Wisely ® : Things we do for no reason

Choosing Wisely ®: Things we do for no reason

Screen for opioid withdrawal and offer and initiate evidence-based treatment, using shared decision making, regardless of the patient's plan to discontinue opioid use or continue treatment after discharge. More than 50 years of data demonstrate that methadone is safe and effective when appropriately titrated. In one study, methadone dose was only weakly associated with QT prolongation and not with cardiac events.

Choosing Wisely ® : Things we do for no reason

Choosing Wisely ®: Things we do for no reason

Las afecciones en las que la presión arterial desempeña un papel importante, como la exacerbación de la insuficiencia cardíaca congestiva, el accidente cerebrovascular agudo o el síndrome coronario agudo, probablemente se benefician de la intensificación de los antihipertensivos. La evidencia de un estudio de cohorte retrospectivo de pacientes mayores de 65 años hospitalizados por diagnósticos no cardíacos en el sistema de administración de salud para veteranos.

NICE

NICE

Before offering iodine-based contrast media to adults, it is recommended to evaluate their risk of acute kidney injury, but without delaying emergency imaging. An increased risk is associated with chronic kidney disease (adults with an eGFR less than 40 ml/min/1.73 m2 are at particular risk), diabetes, but only with chronic kidney disease, heart failure, kidney transplant, over 75 years, hypovolemia, increased volume of contrast agent, intra-arterial administration of contrast medium with ...

Choosing Wisely ® : Things we do for no reason

Choosing Wisely ®: Things we do for no reason

Lactate above 2 mmol/L is associated with increased sepsis severity and mortality, however, lactate elevation may not be indicative of the current perfusion state. Evidence suggests that during states of increased metabolic demand, which can otherwise be thought of as physiologic stress in the critically ill, hyperlactatemia develops. Lactate should be used as an adjunctive screening of patients who may have sepsis to aide in risk stratification of those patients who may need more monitoring. ...