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Avoid the routine use of “whole-body” diagnostic computed tomography (CT) scanning in patients with minor or single system trauma.
Choosing Wisely Canada
Canadian Association of General Surgeons - Canadian Medical Association - University of Toronto
Aggressive use of “whole-body” CT scanning improves early diagnosis of injury and may even positively impact survival in polytrauma patients. However, the significance of radiation exposure with these studies must be considered, especially in patients with low energy mechanisms of injury and absent physical examination findings consistent with major trauma.
ver más ... 2014Don’t perform axillary lymph node dissection for clinical stages I and II breast cancer with clinically negative lymph nodes without attempting sentinel node biopsy.
Choosing Wisely Canada
Canadian Association of General Surgeons
Sentinel node biopsy is proven effective at staging the axilla for positive lymph nodes and is proven to have fewer short and long term side effects, and in particular is associated with a markedly lower risk of lymphedema (permanent arm swelling). When the sentinel lymph node(s) are negative for cancer, no axillary dissection should be performed. When one or two sentinel nodes are involved with cancer that is not extensive in the node, the patient received breast conserving surgery and is ...
ver más ... 2014Asymptomatic bacteriuria should not be treated routinely with antibiotics, except for pregnant women and other very specific cases
Essencial: Afegint valor a la pràctica clínica [Essencial: Adding value to the clinical practice]
Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS)
Asymptomatic bacteriuria is defined as an increase of more than 100,000 CFU / mL of uropathogens in a urine culture, in the absence of urinary tract infection symptoms. In general, to establish the diagnosis it is required to get two consecutive urine cultures yielding the same organism. The existence of asymptomatic bacteriuria increases the chance of developing a symptomatic urinary tract infection ( 0.2 to 0.9 per 1,000 person-days) usually cystitis, rarely acute pyelonephritis, and ...
ver más ... 2014It is recommended to use supervised Intermittent Androgen Deprivation in patients with prostate cancer who need a long treatment with hormonal therapy* and have no signs of clinical progression after
Iniciativa MAPAC (Mejorar la Adecuación de la Práctica Asistencial y Clínica)
Hospital de Sant Pau
* (PSA <4ng/ml in advanced stage and PSA <0.5 ng / ml in relapsing cases) The supervised Intermittent Androgen Deprivation therapy (PSA revisions every 3 or 6 months) improves the quality of life for patients and reduces the adverse effects of medication. Various studies have shown that the IAD is at least as effective as the continuous, and is better tolerated.
ver más ... 2014In adult patients with anemia due to chronic kidney disease who receive erythropoiesis-stimulating agent, is not recommended achieving normal levels of hemoglobin as target range*
Iniciativa MAPAC (Mejorar la Adecuación de la Práctica Asistencial y Clínica)
Hospital de Sant Pau
* It is recommended to maintain the desired hemoglobin level between 10 -12 g / dl. To maintain Hb within recommended levels, you should not wait for these levels to be out of range before adjusting treatment, actions could be taken when Hb levels are 0.5 g / dl close to the limit.
ver más ... 2014