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Choosing Wisely UK

Royal College of Physicians

According to the NICE guide of "NICE guidance on Transient Loss of Consciousness" a neurological and cardiological study should be done before any other investigation, with some exceptions: - Older people (older than 50 years) with a new onset of epileptic seizures do not need an EEG, unless they have very frequent or continuous seizures. - Repeated standard EEGs may be useful when the diagnosis of epilepsy or syndrome is unclear. However, if the diagnosis has been established, repeat EEGs may ...

Choosing Wisely UK

Faculty of Sexual and Reproductive Health

Menopause is when a woman stops having periods as she reaches the end of her natural reproductive life. This is not usually abrupt, but a gradual process during which women experience perimenopause before reaching postmenopause. The average age of menopause in the UK is 51. However, this varies widely and 1 in 100 women experience premature ovarian insufficiency (menopause occurring before the age of 40 years). The follicle-stimulating hormone (FSH) test is often performed unnecessarily in ...

Choosing Wisely UK

British Society of Rheumatology

Patients with suspected inflammatory arthritis should be referred to Rheumatology without delay. Rheumatoid factor and CCP/ACPA are important, but should be avoided as screening tests. A negative result does not exclude rheumatoid arthritis, nor does a positive result equate to a diagnosis of rheumatoid arthritis. Repeat testing is not normally indicated.

Choosing Wisely UK

Royal College of Physicians

Do not routinely offer imaging in a non-specialist setting for people with low back pain with or without sciatica. Explain to people with low back pain with or without sciatica that if they are being referred for specialist opinion, they may not need imaging. Consider imaging in specialist settings of care (for example, a musculoskeletal interface clinic or hospital) for people with low back pain with or without sciatica only if the result is likely to change management. For more information ...

Choosing Wisely UK

Royal College of Physicians

When managing patients with migraine only perform neuro-imaging where there are atypical features. It is essential to clarify patient expectations and provide education and explanation about the differential diagnosis of migraine. Patients with new onset headaches should have a neurological examination (including fundoscopy) and assessment of ‘red flags’ as per NICE guidance. Where, based on clinical need and imaging is required, unless in a history of trauma or suspected subarachnoid, MRI ...