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Do not use endoscopy for investigation in gastric band patients with symptoms of reflux.
Choosing Wisely Australia
Royal Australasian College of Surgeons
The treatment of reflux in gastric band patients should be carefully considered. Endoscopy should not be used without consideration of alternative strategies. Reflux in gastric band patients is often related to the device. It is best managed by removal of fluid, in consultation with a Bariatric Surgeon or other appropriately qualified person.
ver más ... 2016Don’t transfuse more units of blood than absolutely necessary, noting that many hospitals have developed policies on indications for transfusion with a view to minimisation.
Choosing Wisely Australia
Royal Australasian College of Surgeons
The limited blood resources available within the health system and the lack of evidence to support transfusing more blood than required necessitate the use of appropriate guidelines. Patients should be carefully evaluated (through use of applicable guidelines) when being assessed for blood transfusions and closely monitored.
ver más ... 2016Do not use ultrasound for the further investigation of clinically apparent groin hernias. Ultrasound should not be used as a justification for repair of hernias that are not clinically apparent.
Choosing Wisely Australia
Royal Australasian College of Surgeons
The role of ultrasound in the diagnosis and treatment of groin hernias is limited. When the clinical diagnosis of a groin hernia is uncertain, any sonographic findings should be interpreted in conjunction with clinical judgment and treated conservatively. The diagnostic accuracy of ultrasound is reduced in the absence of any clinically palpable hernia
ver más ... 2016Don’t perform repair of minimally symptomatic or asymptomatic inguinal hernias without careful consideration, particularly in patients who have significant co-morbidities.
Choosing Wisely Australia
Royal Australasian College of Surgeons
The proportion of patients presenting with inguinal hernias who are suffering significant co-morbidities is increasing. In these populations and in the presence of multiple of co-morbidities, the importance of carefully assessing the risks and benefits of surgical intervention is vital. Studies have shown that adoption of a watch and wait approach does not heighten the risk of the patient developing more severe symptoms. In cases of minimally symptomatic and asymptomatic inguinal hernias, the ...
ver más ... 2016Monotherapy for acne with either topical or systemic antibiotics should be avoided. Combine with topical antiseptics such as benzoyl peroxide to reduce antibiotic resistance
Choosing Wisely Australia
The Australasian College of Dermatologists
Acne is a very common disorder in adolescence often persisting into the early 20s. Treatment may be necessary over many years. Current evidence suggests that the antibiotics effective in acne exert an anti-inflammatory effect rather than a bactericidal effect.
ver más ... 2016