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The use of external beam radiotherapy after oesophageal cancer and oesophagogastric junction stenting is recommended for people with prolonged post-intervention bleeding or a known bleeding disorder.
NICE
NICE
A high quality health technology assessment in the UK provided new evidence on external beam radiotherapy after stenting in people with dysphagia whose condition needed palliation, and the committee agreed that it did not support the routine use of external beam radiotherapy. However, the committee noted that there was some evidence of improved outcomes for gastrointestinal tract-related bleeding. Although this was of low certainty, they agreed that, in their experience, external beam ...
ver más ... 2023It is not recommended to order random urine protein electrophoresis to screen for a monoclonal gammopathy in patients without unexplained “CRAB” symptoms or diseases associated with monoclonal ...
Choosing Wisely Canada
Canadian Society of Clinical Chemists
Screening for monoclonal gammopathies should only be performed in patients with unexplained “CRAB” symptoms (hyperCalcemia, Renal insufficiency, Anemia, or lytic Bone lesions) or diseases associated with monoclonal gammopathies. For such patients, serum protein electrophoresis (SPE) should be the initial screening test with follow-up immunofixation electrophoresis (IFE) if indicated.
ver más ... 2023It is recommended not to repeat the HbA1c testing within 3 months of a previous result in patients with diabetes.
Choosing Wisely Canada
Canadian Society of Clinical Chemists
The lifespan of a red blood cell is approximately 90-120 days, thus the effects of a patient’s change in behaviour, diet, or newly adjusted medications will not be reflected in the HbA1c measurement until most of the previous RBCs in circulation are replaced (~90 days). Therefore, testing at time intervals earlier than 3 months does not allow enough time to pass to reach the treatment target or new steady-state. Overtesting may lead to unnecessary regimen changes, adverse effects, and higher ...
ver más ... 2023It is recommended the use of intracutaneous or subcutaneous sterile water injections as a pain relief option for women in labour with back pain.
NICE
NICE
This guideline covers the care of women who go into labor at term (37+0 to 41+6 weeks). The care a woman receives during childbirth has the potential to affect her (both physically and emotionally, in the short and long term) and the health of her baby. Good communication, support and compassion from staff, and respect for her wishes can help her feel in control of what is happening and help make birth a positive experience for the woman and her companions. . An example of caring for women at ...
ver más ... 2023Hay incertidumbre sobre si la consulta médica preoperatoria reduce los resultados adversos postoperatorios.
Less Is More Collection - JAMA Network
JAMA Network
In this cohort study, preoperative medical consultation was not associated with a reduction but rather with an increase in adverse postoperative outcomes, suggesting a need for further refinement of target populations, processes, and interventions related to preoperative medical consultation. These findings highlight the need for further research and suggest that referral for preoperative medical consultation and subsequent testing should be carefully guided by individual-level consideration of ...
ver más ... 2023