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Do recommend performing interventions that provide advice or feedback to doctors to improve antibiotic prescribing practices.
Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]
Mayor S. BMJ 2017;356:j713
Reviewers searched the literature for studies investigating the effectiveness and safety of interventions designed to improve antibiotic prescribing in hospital inpatients. They included a total of 221 studies (58 randomised and 163 non-randomised), published before January 2015 and mostly carried out in Europe and North America.
ver más ... 2017Don’t repeat hepatitis C viral load testing in an individual who has established chronic infection, outside of antiviral treatment.
Choosing Wisely Canada
Canadian Association for the Study of Liver Disease
Highly sensitive quantitative assays of hepatitis C RNA are appropriate at the time of diagnosis (to confirm infection) and as part of antiviral therapy, which is typically at the beginning and after therapy is completed to confirm sustained virological response at week 12 (SVR 12). Outside of these circumstances the results of virologic testing do not change clinical management or outcomes.
ver más ... 2017Don’t perform computed tomography (CT) or magnetic resonance imaging (MRI) routinely to monitor benign focal liver lesions (e.g., focal nodal hyperplasia, hemangioma).
Choosing Wisely Canada
Canadian Association for the Study of Liver Disease
Patients with benign focal liver lesions who do not have underlying liver disease and have demonstrated clinical (asymptomatic) and radiologic stability do not need repeated imaging as the likelihood of evolving into neoplastic lesions is very low. In contrast, patients with radiologic evidence of hepatocellular adenoma may have an increased risk of complications and/or neoplasia thus warranting closer observation.
ver más ... 2017Don’t order HFE genotyping based on serum ferritin values alone to diagnose hereditary hemochromatosis.
Choosing Wisely Canada
Canadian Association for the Study of Liver Disease
Serum ferritin values reflect an increase in hepatic iron content and have a significant false positive rate because of elevations due to inflammation. Thus, in patients with evidence of liver disease, hemochromatosis genotyping should only be performed among individuals with an elevated ferritin and fasting transferrin saturation >45% (TSat) or a known family history of HFE-associated hereditary hemochromatosis.
ver más ... 2017Don’t routinely transfuse fresh frozen plasma, vitamin K, or platelets to reverse abnormal tests of coagulation in patients with cirrhosis prior to abdominal paracentesis, endoscopic variceal band ...
Choosing Wisely Canada
Canadian Association for the Study of Liver Disease
Routine tests of coagulation do not reflect bleeding risk in patients with cirrhosis and bleeding complications of these procedures are rare.
ver más ... 2017