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Choosing Wisely ® : Things we do for no reason

Rebeca Gomez et al.

Chest pain is the second most common presenting complaint in emergency departments in the United States. Although traditionally repeated ECGs increase the likelihood of identifying significant changes, advances in cardiac enzyme tests have resulted in more accurate ways to identify acute cardiac problems and ischemia. In addition, routine ECGs at prespecified time intervals regardless of symptoms may lead to necessary tests and treatment without improving outcomes. It is only recommended to ...

Choosing Wisely ® : Things we do for no reason

Choosing Wisely ® : Things we do for no reason

Guidelines recommend that high‐risk, stabilized patients receive an early invasive management strategy (defined as ICA within 24 h of admission). If ICA leads to a percutaneous coronary intervention (PCI) with stent placement, then dual‐antiplatelet therapy (DAPT) is indicated, typically with aspirin and an oral P2Y12 inhibitor, such as clopidogrel, ticagrelor, or prasugrel. For patients with an NSTE‐ACS, providers typically start oral P2Y12 inhibitor with a loading dose in one of two ...

Less Is More Collection - JAMA Network

Groenendyk et al.

Prediction of coronary heart disease (CHD) risk is the cornerstone of prevention strategies. Polygenic risk scores (PRS) have emerged as a new approach to predict risk in asymptomatic people. Polygenic risk scores for CHD have been studied in various populations, but there is disagreement about the incremental value of PRS beyond traditional risk factor scores in the primary prevention of CHD. This study is a narrative review critically appraised the 5 most cited studies published up to 2021 ...

Less Is More Collection - JAMA Network

Bell et al.

Coronary artery calcium scores are used to help assess patients’ cardiovascular status and risk. However, their best use in risk assessment beyond traditional cardiovascular factors in primary prevention is uncertain. Coronary artery calcium score appears to add some further discriminations to the traditional cardiovascular disease risk assessment equations. However, the modest gain may often be outweighed by costs, rates of incidental findings, and radiation risks. Evidence comes from 6 ...

Less Is More Collection - JAMA Network

Piette et al.

Cognitive behavioral therapy for chronic pain (CBT-CP) is a safe and effective method that is an alternative to opioid analgesics. Because CBT-CP requires multiple sessions and therapists are in short supply, many patients have limited access or do not complete treatment. This study was a randomized non-inferiority comparative effectiveness trial that included 278 patients with chronic back pain from the Department of Veterans Affairs Health System (recruitment and data collection from ...