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Don’t routinely collect or process specimens for Clostridium difficile testing in infants less than one year of age with diarrhea.
Choosing Wisely Canada
Association of Medical Microbiology and Infectious Disease Canada
Infants are commonly asymptomatic carriers of C. difficile (14-63%), but clinical illness is rarely reported before 12-24 months of age. It has been hypothesized that infants lack the cellular machinery for Clostridium toxin internalization. When investigating an infant with diarrhea, alternative diagnoses should be considered even with a positive test for C. difficile. Testing should be limited to immunosuppressed infants or those with underlying intestinal conditions (e.g. Hirschsprung ...
ver más ... 2018Don’t use a bag for collection of urine cultures to diagnose urinary tract infections.
Choosing Wisely Canada
Association of Medical Microbiology and Infectious Disease Canada
Bacterial growth in cultures of bag urine specimens are more likely to be falsely positive in young children with suspected urinary tract infection (UTI) due to contamination with perineal flora. A bag urine culture cannot therefore be used to establish the diagnosis of UTI and may lead to overtreatment. Although a negative bag culture would rule out a UTI, a positive culture requires confirmation by a more specific method, incurring substantial delay. Cultures of urine specimens obtained by ...
ver más ... 2018Don’t routinely use antibiotics other than amoxicillin in the treatment of children with presumed community-acquired pneumonia (in the outpatient setting).
Choosing Wisely Canada
Association of Medical Microbiology and Infectious Disease Canada
Preschool-aged children with CAP (community acquired pneumonia) frequently do not require antibiotics, as most disease is caused by viral infections. Children with suspected CAP of bacterial origin should usually receive amoxicillin for outpatient treatment, or ampicillin or penicillin G for inpatient treatment. These agents have sufficient activity against the common bacterial pathogens causing CAP without being unnecessarily broad. Third-generation cephalosporins should be reserved for ...
ver más ... 2018Don’t use post-operative splinting of the wrist after carpal tunnel release for long-term relief.
Choosing Wisely Canada
Canadian Orthopaedic Assoc., Canadian Arthroplasty Soc. & Arthroscopy Assoc. of Canada
Routine post-operative splinting of the wrist after the carpal tunnel release procedure showed no benefit in grip or lateral pinch strength or bowstringing. In addition, the research showed no effect in complication rates, subjective outcomes or patient satisfaction. Clinicians may wish to provide protection for the wrist in a working environment or for temporary protection. However, objective criteria for their appropriate use do not exist. Clinicians should be aware of the detrimental effects ...
ver más ... 2018Don’t use lateral wedge insoles to treat patients with symptomatic medial compartment osteoarthritis of the knee.
Choosing Wisely Canada
Canadian Orthopaedic Assoc., Canadian Arthroplasty Soc. & Arthroscopy Assoc. of Canada
In patients with symptomatic osteoarthritis of the knee, the use of lateral wedge or neutral insoles does not improve pain or functional outcomes. Comparisons between lateral and neutral heel wedges were investigated, as were comparisons between lateral wedged insoles and lateral wedged insoles with subtalar strapping. The systematic review concludes that there is only limited evidence for the effectiveness of lateral heel wedges and related orthoses. In addition, the possibility exists that ...
ver más ... 2018