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Smarter medicine

Sociedad Suiza de Medicina Intensiva

The expected positive effects of not systematically performing anti-ulcer prophylaxis in intensive medicine are the reduction in medication consumption and associated costs and the reduction in induced complications (pneumonia acquired in intensive care). Instead, it is recommended to carry out a prior evaluation of the risk/benefit balance and promote enteral nutrition. This measure is supported by: intervention studies, meta-analyses, recommendations from professional societies and groups of ...

Smarter medicine

Sociedad Profesional Suiza de Geriatría

People with dementia often exhibit aggression, resistance to attention, and other problem or disruptive behaviors. In such circumstances, antipsychotic medications are often prescribed, but they have limited and variable benefits while carrying risks, such as excessive sedation, cognitive impairment, and increased risk of falls, stroke, and heart failure. The use of these drugs in patients with dementia should be limited to cases where non-pharmacological measures have failed and the patients ...

Choosing Wisely Australia

Australasian Faculty of Rehabilitation Medicine

The majority of acute low back pain episodes are benign, self-limited cases that do not warrant the use of imaging (e.g. X-rays, CT or MRI). There is evidence that early imaging for low back pain in the absence of red flags does not facilitate improvements in primary outcomes such as pain and function, even for older patients. If anything such imaging may be harmful insofar as it may reveal incidental findings that divert attention and increase the risk of having unnecessary interventions and ...

Choosing Wisely Australia

Australasian Faculty of Rehabilitation Medicine

Reviews of the evidence and individual case studies on the use of hand splinting for stroke patients have been unable to find conclusive evidence that it leads to improvements in managing spasticity and preventing contractures or more generally improving upper limb function. Moreover, there is high quality evidence that stretch, whether administered from splints or other means, does not have clinically important effects on joint mobility in people with or without neurological conditions, at ...

Choosing Wisely Australia

Australasian Faculty of Rehabilitation Medicine

Studies of patients with osteoporotic fractures have found that they are at significantly greater risk of suffering a new fracture compared to the general population. This risk is particularly marked in but not restricted to elderly patients, particularly given that recent clinical guidelines recommend that all individuals over the age of 50 who sustain a fracture following minimal trauma (such as a fall from standing height or less) should be considered to have a presumptive diagnosis of ...