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Do not use electroencephalography (EEG) for headaches.
Smarter medicine
Société Suisse de Neurologie (SSN)
EEG has no advantage over clinical evaluation in diagnosing headache, does not improve clinical outcomes, and increases costs. Recurrent headaches are the most common pain problem and affect 15 to 20% of people.
ver más ... 2018Avoid, if possible, the insertion of venous catheters for patients with chronic stage 4-5 renal disease into an arm potentially amenable to an arteriovenous fistula.
Smarter medicine
Société Suisse de Néphrologie (SSN)
Preservation of venous capital is critical in stage 4-5 of CKD patients. Arteriovenous fistulas (AVFs) are the best access for hemodialysis, with fewer complications and lower patient mortality than transplants or catheters. Excessive venipuncture damages veins, destroying potential AVF sites. PICC lines (peripherally inserted central catheters) and subclavian vein punctures may cause venous thrombosis and central venous stenosis. Early consultation in nephrology increases the use of AVF at the ...
ver más ... 2018Do not start treatment with erythropoiesis stimulating agents (erythropoietin, ESA) for asymptomatic patients with chronic kidney disease with hemoglobin levels ≥10 g/dl.
Smarter medicine
Société Suisse de Néphrologie (SSN)
The administration of ESA to patients with chronic kidney disease to normalize their hemoglobin levels has no proven benefit in terms of survival or cardiovascular disease, and may be harmful compared to a treatment regimen that delays ESA administration or sets relatively standard objectives (9-11g/dL). ESAs should be prescribed to keep hemoglobin at its lowest level, both to limit transfusions and to best meet the needs of each patient.
ver más ... 2018Avoid nonsteroidal anti-inflammatory drugs (NSAIDs) in people with hypertension, heart failure, and/or chronic kidney disease.
Smarter medicine
Société Suisse de Néphrologie (SSN)
For the pharmacological treatment of musculoskeletal pain, the use of NSAIDs, including cyclooxygenase type 2 (COX-2) inhibitors, may raise blood pressure, render antihypertensives less effective, cause fluid retention, and aggravate renal function. Other agents, such as paracetamol, tramadol or short-term use of narcotic analgesics, may be safer and as effective as NSAIDs.
ver más ... 2018Do not perform cancer screening in asymptomatic end-stage renal disease patients without first discussing the risks and benefits.
Smarter medicine
Société Suisse de Néphrologie (SSN)
In end-stage renal disease patients with limited life expectancy, oncologic screening - including mammography, colonoscopy, prostate specific antigen (PSA) and vaginal smears - does not improve survival. False positive tests can be harmful and induce unnecessary procedures, overtreatment, incorrect diagnosis and increased stress. An individualized approach to cancer screening, integrating patient risk factors, life expectancy and transplantation status, is needed.
ver más ... 2018