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Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]

Dyer O. BMJ 2019;364:l515

Percutaneous vertebroplasty provides no demonstrable clinically significant benefit over placebo. While patients who had these surgeries may have had a short term reduction in pain, we found that there was no significant benefit over the long term in improving pain, back related disability, and quality of life when compared with those who did not have the procedures.

Prescrire bilan. Towards better patient care: drugs to avoid

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Bupropion, an amphetamine authorised for smoking cessation, is no more effective than nicotine but can cause neuropsychiatric disorders (including aggressiveness, depression and suicidal ideation), potentially severe allergic reactions (including angioedema and Stevens-Johnson syndrome), addiction, and congenital heart defects in children exposed to the drug in utero.

Choosing Wisely®

Society for Maternal-Fetal Medicine

Amniotic fluid volume can be measured using either the amniotic fluid index (AFI) or the deepest vertical pocket (DVP). Diagnosis of oligohydramnios based on an AFI of <5 cm has been found to lead to a greater number of obstetric interventions without a significant benefit in improving perinatal outcomes when compared to use of a DVP of <2 cm for diagnosis.

Choosing Wisely®

Society for Maternal-Fetal Medicine

Subclinical hypothyroidism (SCH) is defined as an elevated serum TSH level in the presence of a normal free T4 level and is found in 2% to 5% of otherwise healthy pregnant women. SCH is unlikely to progress to overt hypothyroidism during pregnancy. While some authorities and organizations have recommended routine screening for all pregnant women and subsequent treatment with levothyroxine, two recent, large (>100,000 women) prospective randomized clinical trials of screening and treatment for ...

Choosing Wisely®

Society for Maternal-Fetal Medicine

MTHFR is responsible for the conversion of 5,10-methylenetetrahydrofolate to 5-methyltetrahydrofolate. Genetic variant C677T and A1286C have been associated with a mild decrease in enzymatic activity, which in the setting of reduced folate levels has been found to be a risk factor for hyperhomocysteinemia. Although hyperhomocysteinemia is a risk factor for cardiovascular disease and venous thrombosis, its cause is multifactorial and independent of the MTHFR genotype, even in homozygotic ...