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Antidepressants are more effective than placebo for short term treatment of acute depression in adults.
Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]
Rimmer A. BMJ 2018;360:k847
A meta-analysis found that all antidepressants were more effective than placebo. The limitations that we can’t predict which antidepressant would be best for an individual, but knowing which antidepressants are better than others can help the decision making. For further information please visit the website of the initiative (link below)
ver más ... 2018The NICE guidance recommends prescribing a narrow spectrum antibiotic, with nitrofurantoin and trimethoprim as first choice options in non-pregnant women, depending on a patient’s kidney function ...
Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]
Mayor S. BMJ 2018;361:k2076
Very little evidence was found on the use of antibiotics in men with a lower UTI but, because of the potential risk of complications, the draft guidance suggests prescribing an antibiotic immediately and sending a midstream urine sample for culture and susceptibility testing.
ver más ... 2018Avoid using an upper GI series to investigate dyspepsia.
Choosing Wisely Canada
Canadian Association of Gastroenterology
Upper GI series are often requested for the investigation of upper gastrointestinal symptoms. This investigation has a significant proportion of false positive and false negative results compared with endoscopy, and studies have consistently found that this is not a cost-effective approach compared to other strategies of managing dyspepsia.
ver más ... 2018Don’t maintain long term Proton Pump Inhibitor (PPI) therapy for gastrointestinal symptoms without an attempt to stop/reduce PPI at least once per year in most patients.
Choosing Wisely Canada
Canadian Association of Gastroenterology
PPIs are effective drugs for the treatment of gastro-esophageal reflux disease (GERD). Patients should always be prescribed the lowest dose of drug that manages their symptoms. Even though GERD is often a chronic condition, over time the disease may not require acid suppression and it is important that patients do not take drugs that are no longer necessary. For this reason patients should try stopping their acid suppressive therapy at least once per year. Patients with Barrett’s esophagus, ...
ver más ... 2018Don’t initiate opioids long-term for chronic pain until there has been a trial of available non-pharmacological treatments and adequate trials of non-opioid medications.
Choosing Wisely Canada
College of Family Physicians of Canada
Depending on the pain mechanism and patient co-morbidities, this can includeacetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), serotonin and norepinephrine reuptake inhibitors (SNRIs), tricyclics and gabapentinoids. Other non-medication modalities for managing acute, subacute and chronic pain may include exercise, weight loss, cognitive-behavioural therapy, massage therapy, physical therapy and/or spinal manipulation therapy. An opioid trial should be guided by clear criteria ...
ver más ... 2018