{"id":901,"date":"2014-03-24T11:27:53","date_gmt":"2014-03-24T18:27:53","guid":{"rendered":"https:\/\/phcprimarycare.org\/?p=901"},"modified":"2014-03-25T15:15:04","modified_gmt":"2014-03-25T22:15:04","slug":"its-time-for-another-choosing-wisely-update","status":"publish","type":"post","link":"https:\/\/phcprimarycare.org\/?p=901","title":{"rendered":"It\u2019s time for another Choosing Wisely update!"},"content":{"rendered":"<p>(See previous blog posts: <a href=\"https:\/\/phcprimarycare.org\/?p=101\">https:\/\/phcprimarycare.org\/?p=101<\/a> and <a href=\"https:\/\/phcprimarycare.org\/?p=346\">https:\/\/phcprimarycare.org\/?p=346<\/a>.)<\/p>\n<p>As a refresher, Choosing Wisely was created \u201cto promote conversations between physicians and patients by helping patients choose care that is:<\/p>\n<ul>\n<li>Supported by evidence<\/li>\n<li>Not duplicative of other tests or procedures already received<!--more--><\/li>\n<li>Free from harm<\/li>\n<li>Truly necessary\u201d<\/li>\n<\/ul>\n<p>To help guide this ideal, national specialty organizations were asked to develop five tests or procedures common to their field which need to be discussed and\/or questioned. The results are the following lists: <a title=\"Lists\" href=\"http:\/\/www.choosingwisely.org\/doctor-patient-lists\/\">Five Things Physicians and Patients Should Question<\/a>.<\/p>\n<p>Choosing Wisely has partnered with many <a href=\"http:\/\/www.choosingwisely.org\/partners\/choosing-wisely-consumer-partners\/\">consumer organizations<\/a>, such as AARP, Covered California, and Consumer Reports, to further disseminate this information in patient-friendly formats.<\/p>\n<p>Most specialty societies have been involved, including in my own field of pediatrics. The American Academy of Pediatrics (AAP) had developed their \u201cList of 5\u201d previously and <a href=\"http:\/\/www.aap.org\/en-us\/about-the-aap\/aap-press-room\/pages\/As-Part-of-Choosing-Wisely-Campaign-American-Academy-of-Pediatrics-Released-Second-List-of-Commonly-Used-Tests.aspx\">just recently<\/a> added five more!<\/p>\n<p>The original five:<\/p>\n<p>1)\u00a0\u00a0\u00a0 Antibiotics should not be used for apparent viral respiratory illnesses (sinusitis, pharyngitis, bronchitis).<\/p>\n<p>2)\u00a0\u00a0\u00a0 Cough &amp; cold medicines should not be prescribed or recommended for respiratory illnesses in children under 4 years of age.<\/p>\n<p>3)\u00a0\u00a0\u00a0 CT scans are not necessary in the immediate evaluation of minor head injuries; clinical observation\/<a href=\"http:\/\/www.mdcalc.com\/pecarn-pediatric-head-injury-trauma-algorithm\/\">PECARN criteria<\/a> should be used to determine whether imaging is necessary.<\/p>\n<p>4)\u00a0\u00a0\u00a0 Neuroimaging is not necessary in a child with a simple febrile seizure.<\/p>\n<p>5)\u00a0\u00a0\u00a0 CT scans are not necessary in the routine evaluation of abdominal pain.<\/p>\n<p>And the new quintet:<\/p>\n<p>6)\u00a0\u00a0\u00a0 Don\u2019t prescribe high-dose dexamethasone (0.5mg\/kg per day) for the prevention or treatment of bronchopulmonary dysplasia in the pre-term infant.<\/p>\n<p>7)\u00a0\u00a0\u00a0 Don\u2019t perform screening panels for food allergies without previous consideration of medical history.<\/p>\n<p>8)\u00a0\u00a0\u00a0 Avoid using acid blockers and motility agents such as metoclopramide for physiologic gastroesophageal reflux (GER) that is effortless, painless, and not affecting growth.\u00a0Do not use medication in the so-called \u201chappy-spitter.\u201d<\/p>\n<p>9)\u00a0\u00a0\u00a0 Avoid the use of surveillance cultures for the screening and treatment of asymptomatic bacteruria.<\/p>\n<p>10)\u00a0\u00a0\u00a0Infant home apnea monitors should not be routinely used to prevent Sudden Infant Death Syndrome (SIDS).<\/p>\n<p>These lists should be more widely publicized, as I was not even aware of this initiative until I attended a recent conference where it was the focus. I know I have been guilty of #7 but am surprised about #10 as I haven\u2019t seen a request for a home apnea monitor in probably a decade!<\/p>\n<p>Given our increasingly complex and expensive health care system, these recommendations can certainly be an inroad to slowing down overuse of certain treatments and procedures.<\/p>\n<p>Jeff Ribordy, MD<\/p>\n","protected":false},"excerpt":{"rendered":"<p>(See previous blog posts: https:\/\/phcprimarycare.org\/?p=101 and https:\/\/phcprimarycare.org\/?p=346.) As a refresher, Choosing Wisely was created \u201cto promote conversations between physicians and patients by helping patients choose care that is: Supported by evidence Not duplicative of other tests or procedures already received<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[15,13],"tags":[],"class_list":["post-901","post","type-post","status-publish","format-standard","hentry","category-medical-practice","category-prevention"],"jetpack_featured_media_url":"","_links":{"self":[{"href":"https:\/\/phcprimarycare.org\/index.php?rest_route=\/wp\/v2\/posts\/901","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/phcprimarycare.org\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/phcprimarycare.org\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/phcprimarycare.org\/index.php?rest_route=\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/phcprimarycare.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=901"}],"version-history":[{"count":6,"href":"https:\/\/phcprimarycare.org\/index.php?rest_route=\/wp\/v2\/posts\/901\/revisions"}],"predecessor-version":[{"id":909,"href":"https:\/\/phcprimarycare.org\/index.php?rest_route=\/wp\/v2\/posts\/901\/revisions\/909"}],"wp:attachment":[{"href":"https:\/\/phcprimarycare.org\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=901"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/phcprimarycare.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=901"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/phcprimarycare.org\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=901"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}