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Choosing Wisely ® : Things we do for no reason

MPH, DeFries T.

Alcohol Use Disorder increases the risk of vitamin deficiency due to the toxic effect of alcohol on the gastrointestinal tract and liver and because of the caloric replacement of nutrient-rich intake with alcohol. Since the body is not capable of storing soluble vitamins, they must be ingested on a regular basis. In clinical practice, we treat discharged patients with this condition empirically with thiamin, folate, and other vitamins to reduce morbidity associated with nutritional ...

Choosing Wisely ® : Things we do for no reason

JHM, Cunningham

Based on current evidence, CT has similar diagnostic accuracy to ultrasound for biliary and gynecologic pathologies necessitating urgent surgery (eg, acute cholecystitis, ovarian torsion), and a follow-up ultrasound adds little. Ultrasonography should be ordered as the initial imaging test when pacients present right upper quadrant abdominal pain or pelvic pain of suspected gynecological origin. It is not recommended to order an ultrasonography 24-48 hours after a negative CT to pursue biliary ...

Choosing Wisely ® : Things we do for no reason

JHM, Memari

Urinary infection can be the cause of an episode of delirium. The article does not recommend routine urinalysis and culture in older patients with delirium without symptoms of local or systemic infection. Try to identify the cause of the mental deterioration using information obtained from a reliable informant, perform a complete physical and neurological examination, and evaluate metabolic and electrolyte parameters. In case of localized or systemic symptoms of infection, routine urinary ...

Choosing Wisely ® : Things we do for no reason

JHM, Glisch

Many clinicians prescribe tramadol to patients with chronic pain because, compared to morphine, it binds weakly to the mu receptor. This leads to the belief that it produces less withdrawal syndrome and fewer side effects than other opioids. However, as its metabolism is carried out in the liver by the cytochrome P450 isoenzyme, and it can undergo several genetic polymorphisms, this process can be altered, producing many unpredictable individual variations in the pharmacodynamics of this ...

Choosing Wisely ® : Things we do for no reason

JHM, Patel

Urate-lowering therapy should be considered an essential medication and should be continued during the hospitalization of a patient with a history of gout. It should also be continued in case of an acute flare of gout, as well as in patients with acute or chronic renal failure, although in consultation with a pharmacist if a modification of the dose is necessary for patients with acute renal failure. When the hospitalist not treat urate-lowering therapy as an essential medication on admission, ...