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Do not order custom orthotics or shoe inserts for a child with minimally symptomatic or asymptomatic flat feet.
Choosing Wisely®
American Academy of Pediatrics and the Pediatric Orthopaedic Society of North America
Flexible flat feet are normal physiologic variants commonly found in children and adults. Unlike a painful or rigid flatfoot that requires further workup, if an arch is present when standing on tiptoe, the foot can be managed with observation or over-the-counter orthotics. The use of custom orthotic devices to provide support for the foot does not aid in the development of the arch.
ver más ... 2018Do not order radiographs or advise bracing or surgery for a child less than 8 years of age with simple in-toeing gait.
Choosing Wisely®
American Academy of Pediatrics and the Pediatric Orthopaedic Society of North America
Mild in-toeing is usually a physiologic phenomenon reflecting ongoing maturation of the skeleton. Metatarsus adductus, femoral anteversion, and tibial torsion all contribute to in-toeing and tend to improve with growth. Simply monitoring gait for continued improvement at normal well child examination intervals is adequate until the age of 7–8 unless there is severe tripping and falling or asymmetry. It is not possible to alter the natural evolution using physical therapy, bracing or shoe ...
ver más ... 2018Do not order a screening hip ultrasound to rule out developmental hip dysplasia or developmental hip dislocation if the baby has no risk factors and has a clinically stable hip examination.
Choosing Wisely®
American Academy of Pediatrics and the Pediatric Orthopaedic Society of North America
Hip dysplasia/dislocation is relatively rare, with incidence of approximately 7 per 1,000 births. Studies have shown that universal screening programs for developmental hip instability using ultrasounds to assess otherwise normal appearing hips have a nearly negligible positive yield. There is a substantial false positive rate, with an associated increase in treatment rate, suggesting that babies without hip pathology are being treated. When there are no physical findings or underlying risk ...
ver más ... 2018Don’t obtain radiographic imaging for patients who meet diagnostic criteria for uncomplicated acute rhinosinusitis.
Choosing Wisely®
American Academy of Otolaryngology - Head and Neck Surgery Foundation
Imaging of the paranasal sinuses, including plain film radiography, computed tomography (CT) and magnetic resonance imaging (MRI) is unnecessary in patients who meet the clinical diagnostic criteria for uncomplicated acute rhinosinusitis. Acute rhinosinusitis is defined as up to four weeks of purulent nasal drainage (anterior, posterior or both) accompanied by nasal obstruction, facial pain-pressure-fullness or both. Imaging is costly and exposes patients to radiation. Imaging may be ...
ver más ... 2018Don’t remove hair at the surgical site including the hair on the patient’s head, but if hair must be removed it should be clipped not shaved.
Choosing Wisely®
American Academy of Nursing
Removing hair at the surgical site has long been believed to be associated with an increased rate of surgical site infections because of razor-induced microtrauma. Specifically, shaving the patient’s head prior to neurosurgery can disturb the natural protective effects of hair and skin flora, also causing micro-abrasions to the scalp that can increase the risk of infection. Postoperative wound infections increase the costs and the length of hospital stay. In any type of surgery there are ...
ver más ... 2018