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Choosing Wisely ® : Things we do for no reason

JHM, Kenny

Several studies conclude that applying calcium correction formulas in patients with hypocalcemia or hypoalbuminemia can lead to the belief that calcium levels are normal, leading to treatment withdrawal. Therefore, it is recommended to use tests to calculate serum calcium concentrations to assess calcium homeostasis, avoiding the use of calcium correction to estimate total calcium. In critical patients or with hypoparathyroidism or hyperparathyroidism, it is recommended to obtain iCa levels to ...

Choosing Wisely ® : Things we do for no reason

JHM, Douglas Auth

The use of corticosteroids is not recommended against anaphylaxis due to the associated adverse effects both in the elderly and in children, mainly cardiovascular effects in the elderly, and pneumonia and gastrointestinal problems in children. Even so, if used, it is recommended to administer them intramuscularly, since in this way an increase in cardiovascular risk is not observed, while intravenously it is. In contrast, The American Academy of Allergy, Asthma & Immunology supports that ...

Choosing Wisely ® : Things we do for no reason

JHM, Xu

This clinical practice guideline aims to clarify which tests are appropriate for the diagnosis of Helicobacter pylori. In patients who do not have an endoscopic indication, stool antigen and urea breath tests are recommended. These two tests must be postponed 4 weeks from the last intake of medications that interfere with the results (antibiotics, bismuth, PPIs); H2 antagonists do not interfere. In patients with an endoscopic indication, biopsy is recommended. In cases of bleeding ulcer with a ...

Choosing Wisely ® : Things we do for no reason

JHM, Caton

Acute decompensated heart failure patients with reduced ejection fraction should be treated with evidence-based neurohormonal blockade and initiate loop diuretics to alleviate congestion. It is recommended that these patients be allowed to drink when thirsty in the absence of hyponatremia. Initiating fluid restriction should be considered in those patients with concurrent hyponatremia or resistance to diuretics. In the present day of evidence-based pharmacologic therapies, research indicates ...

Choosing Wisely ® : Things we do for no reason

JHM, Gay

Unintentional weight loss affects more than 27% of older people and up to 60% of people admitted to nursing homes. The search to put an end to this problem has led professionals to opt for the use of orexigens. The problem is that several studies with certain medications have shown an increased risk of thrombi, physical deterioration or adrenal insufficiency, in some cases, such as megestrol acetate, being associated with the possibility of death. Therefore, the American Geriatrics Society does ...