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Choosing Wisely ® : Things we do for no reason

Choosing Wisely ®: Things we do for no reason

Given the low effectiveness of safety indicators in preventing violence and the growing evidence of harm, we recommend significantly reducing their use. For existing ones, we recommend that institutions assess their current relevance (what circumstances surround previous behavioral incidents) and remove obsolete ones. Institutions should evaluate their stigma potential (word choice, tone, criminalizing language) and application (certain patient populations have more indicators than others) as ...

Choosing Wisely ® : Things we do for no reason

Choosing Wisely ®: Things we do for no reason

Current data suggests that patients admitted with acute pancreatitis benefit from hospitalists initiating early oral nutrition. Initial studies investigating the benefit of feeding in pancreatitis revealed an association between bowel rest therapy, usually with parenteral nutrition, and an increased likelihood of the development of disruptions of the gut–mucosal barrier, persistence of the systemic inflammatory response, and admission to the intensive care unit. Indeed, data from human ...

NICE

NICE

Clinical trial evidence suggests that velmanase alfa may lead to improvements in functions such as walking, stair climbing and lung capacity, and quality of life, for people with alpha‑mannosidosis. But the size and nature of these benefits are highly uncertain because of the ultra-rare nature of the condition, which makes evidence generation difficult. The most likely cost-effectiveness estimate for velmanase alfa is around what is considered value for money in the context of a highly ...

Choosing Wisely ® : Things we do for no reason

Choosing Wisely ®: Things we do for no reason

Functional stress tests have served as the standard of care for the evaluation of cardiac ischemia for decades. Before 2021, guidelines recommended a functional stress test as the diagnostic imaging modality of choice for patients with low or intermediate‐risk chest pain. As a result, clinicians most commonly ordered stress tests for the diagnosis of coronary artery disease. Evidence of moderate to severe reversible ischemia on imaging‐based functional stress tests and severe ischemia on ...

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 ...