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It is recommended to be aware that clinical presentations in multiple sclerosis (MS) include: loss or reduction of vision in 1 eye with painful eye movements, double vision, ascending sensory ...
NICE
National Institute for Health and Clinical Excellence (NICE)
1.1 Diagnosing MS Be aware that usually people with MS present with neurological symptoms or signs as described in recommendation 1.1.1, and: are often aged under 50 and may have a history of previous neurological symptoms and have symptoms that have evolved over more than 24 hours and have symptoms that may persist over several days or weeks and then improve. Do not routinely suspect MS if a person's main symptoms are fatigue, depression or dizziness unless they have a history or evidence of ...
ver más ... 2014For people presenting with symptoms of lower respiratory tract infection in primary care, consider a point of care C‑reactive protein test if after clinical assessment a diagnosis of pneumonia has ...
NICE
National Institute for Health and Clinical Excellence (NICE)
Do not routinely offer antibiotic therapy if the C‑reactive protein concentration is less than 20 mg/litre. Consider a delayed antibiotic prescription (a prescription for use at a later date if symptoms worsen) if the C‑reactive protein concentration is between 20 mg/litre and 100 mg/litre. Offer antibiotic therapy if the C‑reactive protein concentration is greater than 100 mg/litre.
ver más ... 2014Avoid repair of minimally symptomatic inguinal hernias where appropriate by offering an option of watchful waiting for up to two years.
Choosing Wisely Canada
Canadian Association of General Surgeons
Repair of minimally symptomatic inguinal hernias in adults can prevent potentially serious complications due to hernia incarceration. However, such repairs can also lead to complications such as infection, chronic inguinal pain and hernia recurrence which cumulatively approximate the risks of incarceration. Evidence shows that such hernias can also be managed with watchful waiting for up to 2 years after assessment, a choice that should be offered to appropriately selected persons.
ver más ... 2014Avoid admission or preoperative chest X-rays for ambulatory patients with unremarkable history and physical exam.
Choosing Wisely Canada
Canadian Association of General Surgeons
Performing routine admission or preoperative chest X-rays is not recommended for ambulatory patients without specific reasons suggested by the history and/or physical examination findings. Only 2 percent of such images lead to a change in management. Obtaining a chest radiograph is reasonable if acute cardiopulmonary disease is suspected or there is a history of chronic stable cardiopulmonary diseases in patients older than age 70 who have not had chest radiography within six months.
ver más ... 2014Avoid colorectal cancer screening tests on asymptomatic patients with a life expectancy of less than 10 years and no family or personal history of colorectal neoplasia.
Choosing Wisely Canada
Canadian Association of General Surgeons
Screening and surveillance modalities are inappropriate when the risks exceed the benefit. The risk of colonoscopy increases with increasing age and comorbidities. The risk/benefit ratio of colorectal cancer screening or surveillance for any patient should be individualized based on the results of previous screening examinations, family history, predicted risk of the intervention, life expectancy and patient preference.
ver más ... 2014