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Choosing Wisely Canada

The Canadian Pediatric Neurosurgery Study Group

Sacrococcygeal dimples (also called simple sacral dimples or sacrococcygeal pits) are common findings in newborns, with a prevalence of approximately 2 to 5%. They are not associated with any increased risk of occult spinal dysraphism (e.g., low lying conus, fatty filum, lipomyelomeningocele, split cord malformation, dermal sinus tract, etc.) compared with the general population of infants without sacrococcygeal dimples. There is therefore no need to investigate infants with this finding, with ...

Choosing Wisely Canada

The Canadian Pediatric Neurosurgery Study Group

A common pediatric neurosurgery referral is a young child with a rapidly increasing head circumference crossing percentiles. The differential diagnosis is broad and includes benign expansion of the subarachnoid spaces (BESS), subdural collections, hydrocephalus, and neoplasm. When the fontanelle is open, the etiology can usually be diagnosed on head ultrasound, and this should therefore be the initial screening test of choice. In the absence of an open fontanelle, or if there are other signs ...

Choosing Wisely Canada

Canadian Nurses Association

Antidepressant response rates are higher for moderate or severe adult depression. For mild depressive symptoms a complete assessment, ongoing support and monitoring, psychosocial interventions and lifestyle modifications should be the first lines of treatment. This approach can avoid the side-effects of medication and establish etiological factors important to future assessment and management. Antidepressants are appropriate in cases of persistent mild depression where a past history of more ...

Choosing Wisely Canada

Canadian Nurses Association

Signs and symptoms suggestive of urinary tract infection (UTI) are increased frequency, urgency, pain or burning on urination, supra-pubic pain, flank pain and fever. Dark, cloudy and/or foul-smelling urine may not be suggestive of UTI but rather of inadequate fluid intake. Cohort studies have found no adverse outcomes associated with asymptomatic bacteriuria for older adults. Not only does antimicrobial treatment for such bacteriuria in older adults show no benefits, it increases adverse ...

Choosing Wisely Canada

Canadian Nurses Association

People with dementia frequently exhibit responsive behaviors, which are often misinterpreted as aggression, resistance to care and challenging or disruptive behaviours. In such instances antipsychotic medicines are regularly prescribed. The benefit of these drugs is limited, however, and they can also cause serious harm including premature death. Their use should be limited to cases where non-pharmacologic measures have failed and where patients pose an imminent threat to themselves or others. ...