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Smarter medicine

Société suisse de Chirurgie (SSC)

Sentinel lymph node biopsy has been shown to be effective in exploring the armpit for abnormal lymph nodes, and has also been shown to have fewer side effects in the short and long term; it is associated with a notably lower risk of lymphoedema (permanent swelling of the arm). If the lymph node(s) are not cancerous, no axillary dissection should be performed. If one or two sentinel lymph nodes are invaded by noninvasive cancer, the patient would have breast conservative surgery and full breast ...

Choosing Wisely Italy. Doing more does not mean doing better (Fare di più non significa fare meglio)

Italian Federation of Primary Care Pediatricians (FIMP)

Very often topical therapies through micronized nasal shower or other nebulizers are prescribed in order to treat upper-respiratory tract infections (particularly otitis, rhinosinusitis, adenoid hypertrophy, rhinopharyngitis, etc.). In most cases the use of corticosteroid and antibiotic drugs is off-label, because indications or route of administration are other than that approved by the Italian Regulatory Agency of Drugs (AIFA) . No official guidelines for the treatment of these infections ...

Choosing Wisely Italy. Doing more does not mean doing better (Fare di più non significa fare meglio)

Italian Federation of Primary Care Pediatricians (FIMP)

Corticosteroids have a strong antipyretic and anti-inflammatory effect. However, their use must be reserved to conditions in which the severity of the anti-inflammatory response threatens the child’s health. These drugs must not be used for treatment of a child with fever due to frequent upper-respiratory infections typical of pre-school age. Systemic corticosteroid medications act by exercising a strong immunosuppressive effect and it could cause opportunistic infections, and/or it could ...

Choosing Wisely Italy. Doing more does not mean doing better (Fare di più non significa fare meglio)

Italian Federation of Primary Care Pediatricians (FIMP)

Paracetamol and ibuprofen are the first-choice antipyretic drugs. Fever needs a pharmacological treatment only if and when it causes malaise and/or it is accompanied by pain. Antipyretic drugs must not be used with the only aim of decreasing the body temperature of the feverish child. The latter method leads to an inappropriate and excessive use of antipyretic medications. Furthermore, very often it leads to a combined/alternate use of paracetamol and ibuprofen that in most cases is not ...

Choosing Wisely Italy. Doing more does not mean doing better (Fare di più non significa fare meglio)

Italian Federation of Primary Care Pediatricians (FIMP)

Urine culture has to be performed after having a urine sample checked for the presence of leucocytes and/or nitrites, with dipstick, or by microscopic urinalysis, and in some special cases, together with urinoculture. In the absence of a pathologic multistick test or urinalysis it is not possible to evaluate if the eventual positive urine culture is due to a real urinary tract infection, to contamination of the specimen, or to occasional bacteriuria. The clean-catch urine specimen is the most ...