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Avoid routine preoperative laboratory testing for low risk surgeries without a clinical indication
Choosing Wisely Canada
Canadian Association of Pathologists - Canadian Medical Association - University of Toronto
Most preoperative laboratory tests (typically a complete blood count, prothrombin time and partial thromboplastin time, basic metabolic panel and urinalysis) performed on elective surgical patients are normal. Findings influence management in under 3% of patients tested. In almost all cases, no adverse outcomes are observed when clinically stable patients undergo elective surgery, irrespective of whether an abnormal test is identified. Preoperative laboratory testing is appropriate in ...
ver más ... 2014Don’t screen women with Pap smears if under 21 years of age or over 69 years of age
Choosing Wisely Canada
Canadian Association of Pathologists - Canadian Medical Association - University of Toronto
Follow provincial guidelines for cervical cancer screening. Screening before the recommended age of initiation (age 21 in most provinces), screening women over the age of 69, or annual screening is not recommended.
ver más ... 2014Don’t perform population based screening for 25-OH-Vitamin D deficiency
Choosing Wisely Canada
Canadian Association of Pathologists - Canadian Medical Association - University of Toronto
Vitamin D deficiency is common in many populations, particularly in patients at higher latitudes, during winter months and in those with limited sun exposure. Over the counter Vitamin D supplements and increased summer sun exposure are sufficient for most otherwise healthy patients. Laboratory testing is appropriate in higher risk patients when results will be used to institute more aggressive therapy (e.g., osteoporosis, chronic kidney disease, malabsorption, some infections).
ver más ... 2014Don’t transfuse red blood cells for arbitrary hemoglobin or hematocrit thresholds in the absence of symptoms, or if no benefit was perceived from previous transfusions
Choosing Wisely Canada
Canadian Society of Palliative Care Physicians - Canadian Medical Association -University of Toronto
Indications for blood transfusion depend on clinical assessment and are also guided by the etiology of the anemia. No single laboratory measurement or physiologic parameter can predict the need for blood transfusion. Transfusions are associated with increased morbidity and mortality in high-risk hospitalized inpatients. Adverse events range from mild to severe, including allergic reactions, acute hemolytic reactions, anaphylaxis, transfusion related acute lung injury, transfusion associated ...
ver más ... 2014Don’t use stool softeners alone to prevent opioid induced constipation
Choosing Wisely Canada
Canadian Society of Palliative Care Physicians - Canadian Medical Association -University of Toronto
Docusate is a widely used stool softener. A review of the evidence found that docusate is no more effective than placebo in the prevention or management of constipation and suggests that the drug has very little utility when given alone for opioid-induced constipation. Compared with placebo, docusate did not increase stool frequency or soften the stool. Docusate also failed to alleviate the common symptoms of opioid-induced constipation such as difficulty passing stools, hard stools, abdominal ...
ver más ... 2014