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Choosing wisely

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https://www.readbyqxmd.com/read/29049500/evidence-based-guidelines-to-eliminate-repetitive-laboratory-testing
#1
Kevin P Eaton, Kathryn Levy, Christine Soong, Amit K Pahwa, Christopher Petrilli, Justin B Ziemba, Hyung J Cho, Rodrigo Alban, Jaime F Blanck, Andrew S Parsons
Routine daily laboratory testing of hospitalized patients reflects a wasteful clinical practice that threatens the value of health care. Choosing Wisely initiatives from numerous professional societies have identified repetitive laboratory testing in the face of clinical stability as low value care. Although laboratory expenditure often represents less than 5% of most hospital budgets, the impact is far-reaching given that laboratory tests influence nearly 60% to 70% of all medical decisions. Excessive phlebotomy can lead to hospital-acquired anemia, increased costs, and unnecessary downstream testing and procedures...
October 16, 2017: JAMA Internal Medicine
https://www.readbyqxmd.com/read/29045684/lean-management-to-support-choosing-wisely-in-healthcare-the-first-evidence-from-a-systematic-literature-review
#2
Maria Crema, Chiara Verbano
Purpose: Choosing Wisely (CW) is an emergent approach to identify and reduce unnecessary care, such as tests and treatments that do not add value for patients and may even cause harm. The purpose of this paper is to investigate whether and how Lean Healthcare Management (LHM) can support CW objectives, focusing on customer needs and on waste elimination. Data sources: A systematic literature review has been performed in Scopus, PubMed and Web of Science. Study selection: Peer reviewed articles published in English language have been selected...
October 17, 2017: International Journal for Quality in Health Care
https://www.readbyqxmd.com/read/29025145/online-physician-ratings-fail-to-predict-actual-performance-on-measures-of-quality-value-and-peer-review
#3
Timothy J Daskivich, Justin Houman, Garth Fuller, Jeanne T Black, Hyung L Kim, Brennan Spiegel
Objective: Patients use online consumer ratings to identify high-performing physicians, but it is unclear if ratings are valid measures of clinical performance. We sought to determine whether online ratings of specialist physicians from 5 platforms predict quality of care, value of care, and peer-assessed physician performance. Materials and Methods: We conducted an observational study of 78 physicians representing 8 medical and surgical specialties. We assessed the association of consumer ratings with specialty-specific performance scores (metrics including adherence to Choosing Wisely measures, 30-day readmissions, length of stay, and adjusted cost of care), primary care physician peer-review scores, and administrator peer-review scores...
September 8, 2017: Journal of the American Medical Informatics Association: JAMIA
https://www.readbyqxmd.com/read/28975616/percutaneous-feeding-tubes-in-individuals-with-advanced-dementia-are-physicians-choosing-wisely
#4
Marzena Gieniusz, Liron Sinvani, Andrzej Kozikowski, Vidhi Patel, Christian Nouryan, Myia S Williams, Nina Kohn, Renee Pekmezaris, Gisele Wolf-Klein
OBJECTIVES: To evaluate physician knowledge and perceptions about the American Board of Internal Medicine/American Geriatrics Society (ABIM/AGS) Choosing Wisely recommendations regarding percutaneous endoscopic gastrostomy (PEG) in individuals with advanced dementia. DESIGN: Multicenter, mixed-mode, anonymous questionnaire. SETTING: Three tertiary and four community hospitals in New York. PARTICIPANTS: Internal medicine physicians (N = 168)...
October 4, 2017: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/28969974/reducing-inappropriate-lumbar-spine-mri-for-low-back-pain-radiology-support-communication-and-alignment-network
#5
Kevin Yuqi Wang, Christopher James Yen, Melissa Chen, Darshan Variyam, Tomas Uribe Acosta, Brian Reed, Max Wintermark, Christie Mary Lincoln
PURPOSE: The aim of this study is to evaluate the impact of educational sessions on reducing lumbar spine MRI inappropriateness for uncomplicated low back pain and to present our institutional experience on the use of ACR's Radiology Support, Communication and Alignment Network (R-SCAN) program toward achieving appropriateness. METHODS: The R-SCAN web portal was accessed to register a project. Using order entry data, the number of lumbar spine MRI orders placed per month at three family medicine clinics was assessed over a 10-month period...
September 21, 2017: Journal of the American College of Radiology: JACR
https://www.readbyqxmd.com/read/28946805/questions-and-answers-in-health-care-and-education
#6
Jill E Thistlethwaite
Questions and answers are integral to the practice of health professionals and their education. Health professionals are taught to ask questions and we expect that patients will answer them. We may also invite patients to ask questions without considering that this may be difficult due to many factors including professional hierarchies. Choosing Wisely is a global initiative that frames questions for patients to ask in relation to tests and treatments. The same concept has been applied to health professional education with students and trainees also being encouraged to question their seniors about their choice of investigations and management...
September 26, 2017: Education for Primary Care
https://www.readbyqxmd.com/read/28942951/the-algorithmic-performance-of-j-tpeak-for-drug-safety-clinical-trial
#7
Simon C Chien, Richard E Gregg
INTRODUCTION: The interval from J-point to T-wave peak (JTp) in ECG is a new biomarker able to identify drugs that prolong the QT interval but have different ion channel effects. If JTp is not prolonged, the prolonged QT may be associated with multi ion channel block that may have low torsade de pointes risk. From the automatic ECG measurement perspective, accurate and repeatable measurement of JTp involves different challenges than QT. We evaluated algorithm performance and JTp challenges using the Philips DXL diagnostic 12/16/18-lead algorithm...
August 15, 2017: Journal of Electrocardiology
https://www.readbyqxmd.com/read/28939983/-drug-therapy-for-older-people-choosing-wisely
#8
REVIEW
Martin Wehling
Elderly people are the most rapidly growing sector of our society. Due to their multimorbidity they are exposed to a multitude of medications, which are accompanied by chances and risks. The problem of inappropriate medication in the elderly is exacerbated by the fact that only a holistic view can help these patients and that this is predominantly the responsibility of the general practitioner. The closely measured paid contact time is often insufficient to optimize complex medications. Clinically successfully tested aids in the form of lists give reason for hope: in particular, the positive/negative assessment of limitations of the elderly with respect to drugs by the STOPP/START criteria and the FORTA classification are clinically successful aids...
September 22, 2017: Zeitschrift Für Gerontologie und Geriatrie
https://www.readbyqxmd.com/read/28939252/does-lymph-node-status-influence-adjuvant-therapy-decision-making-in-women-70-years-of-age-or-older-with-clinically-node-negative-hormone-receptor-positive-breast-cancer
#9
Anees B Chagpar, Nina Horowitz, Tara Sanft, Lynn D Wilson, Andrea Silber, Brigid Killelea, Meena S Moran, Michael P DiGiovanna, Erin Hofstatter, Gina Chung, Lajos Pusztai, Donald R Lannin
BACKGROUND: Women ≥70 years old with clinically (c) lymph node (LN) negative (-), hormone receptor (HR) positive (+) breast cancer are recommended not to be routinely staged with a sentinel LN biopsy. We sought to determine how this affects adjuvant decision-making. METHODS: Statistical analyses were performed to determine the association of LN evaluation with adjuvant chemotherapy and radiation therapy in cLN-, HR + breast cancer patients in the National Cancer Database...
September 19, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/28928507/characteristics-of-xanthosoma-sagittifolium-roots-during-cooking-using-physicochemical-analysis-uniaxial-compression-multispectral-imaging-and-low-field-nmr-spectroscopy
#10
Abena Achiaa Boakye, María Gudjónsdóttir, Jacob Lercke Skytte, Ioannis S Chronakis, Faustina Dufie Wireko-Manu, Ibok Oduro
To effectively promote the industrial utilization of cocoyam (Xanthosoma sagittifolium) roots for enhanced food sustainability and security, there is a need to study their molecular, mechanical and physicochemical properties in detail. The physicochemical and textural characteristics of the red and white varieties of cocoyam roots were thus analysed by low field nuclear magnetic resonance relaxometry, multispectral imaging, uniaxial compression testing, and relevant physicochemical analysis in the current study...
August 2017: Journal of Food Science and Technology
https://www.readbyqxmd.com/read/28925663/top-poems-of-2016-consistent-with-the-principles-of-the-choosing-wisely-campaign
#11
Roland Grad, Mark H Ebell
A challenge in the Choosing Wisely campaign is to identify low-value clinical actions supported by high-quality evidence. We applied a method based on crowdsourcing the Daily POEM (patient-oriented evidence that matters) to identify low-value clinical actions from research studies consistent with the principles of Choosing Wisely. In 2016, we analyzed an average of 1,382 questionnaires on 265 unique POEMs delivered to physician members of the Canadian Medical Association. From these questionnaires, we identified the POEMs ranking highest on one questionnaire item directly linked to reducing overdiagnosis or overtreatment...
August 15, 2017: American Family Physician
https://www.readbyqxmd.com/read/28912198/frequency-of-low-value-care-in-alberta-canada-a-retrospective-cohort-study
#12
Finlay A McAlister, Meng Lin, Jeff Bakal, Stafford Dean
OBJECTIVE: To determine how frequently 10 low-value services highlighted by Choosing Wisely are done and what factors influence their provision. METHODS: This is a retrospective cohort study using routinely collected health data from five linked data sets from 2012 to 2015 in the Canadian province of Alberta to determine the frequency with which 10 low-value services were provided. RESULTS: Between 2012 and 2015, 162 143 people (4% of all 3 814 536 adult Albertans and 5% of the 3 423 135 who saw a physician at least once in that time frame) received at least one of the 10 low-value services, including 29...
September 14, 2017: BMJ Quality & Safety
https://www.readbyqxmd.com/read/28904035/choosing-wisely-canada-recommendations-interview-with-dr-caroline-laberge
#13
Caroline Laberge
No abstract text is available yet for this article.
September 2017: Canadian Family Physician Médecin de Famille Canadien
https://www.readbyqxmd.com/read/28902376/-priorities-of-german-oncologists-results-of-the-choosing-wisely-survey-of-the-german-society-of-hematology-and-medical-oncology-dgho
#14
Stefan W Krause, Michael Oldenburg, Michael Hallek, Andreas Neubauer
Background During the preparation of "choosing wisely" recommendations, the German Society of Hematology and Medical Oncology (DGHO) had performed a member survey. The large body of replies was systematically and quantitatively analyzed for this report. Methods Replies to the draft recommendations are quantified. Free text replies were iteratively categorized in three levels according to medical categories and additionally, according to their general target of necessary action. Results 492 members completed the survey within the given limit of 2 weeks...
September 2017: Deutsche Medizinische Wochenschrift
https://www.readbyqxmd.com/read/28899802/the-new-targeted-therapy-in-systemic-lupus-erythematosus-is-the-glass-half-full-or-half-empty
#15
REVIEW
Andrea Doria, Ricard Cervera, Mariele Gatto, Gamal Chehab, Matthias Schneider
Biologic therapy is still limited in lupus, where chronic steroid exposure and wide-spectrum immunosuppression are major triggers of organ damage. In this viewpoint, the authors summarize their views for a "half-full or half-empty" glass on targeted therapy in SLE. The are several reasons for seeing the glass half-empty and in this section the authors propose a critical reflection on scarceness of novel targeted lupus therapies. They show how hard it is to identify suitable biological and clinical targets and to choose the patients that may best fit those targets, as well as to stratify patients according to disease subtype and response, all contributing to the final outcome...
September 9, 2017: Autoimmunity Reviews
https://www.readbyqxmd.com/read/28891177/cognitive-challenges-to-minimising-low-value-care
#16
Ian A Scott
Clinical decisions often rely on pattern recognition, simple rules of thumb, tacit knowledge and habit. In many instances, such intuitive decisions are fast and accurate, but they can be subject to cognitive biases leading to delivery of care of low value at odds with scientific evidence of best practice. If programmes, such as EVOLVE (Evaluating Evidence, Enhancing Efficiencies) and Choosing Wisely are to have maximal impact in minimising low value care, such biases, and the factors that hide and accentuate them, need to be exposed and addressed in a collegiate and non-judgemental manner...
September 2017: Internal Medicine Journal
https://www.readbyqxmd.com/read/28874933/head-ct-for-minor-head-injury-presenting-to-the-emergency-department-in-the-era-of-choosing-wisely
#17
John DeAngelis, Valerie Lou, Timmy Li, Henry Tran, Praneeta Bremjit, Molly McCann, Peter Crane, Courtney M C Jones
INTRODUCTION: The Choosing Wisely campaign currently recommends avoiding computed tomography (CT) of the head in low-risk emergency department (ED) patients with minor head injury, based on validated decision rules. However, the degree of adherence to this guideline in clinical practice is unknown. The objective of this study was to evaluate adherence to the Choosing Wisely campaign's recommendations regarding head CT imaging of patients with minor head injury in the ED. METHODS: We conducted a retrospective cohort study of adult ED patients at a Level I trauma center...
August 2017: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28872765/digital-therapy-in-diabetes
#18
REVIEW
Avivit Cahn, Amit Akirov, Itamar Raz
Diabetes care is largely dependent on patient self-management and empowerment, given that patients with diabetes must make numerous daily decisions of what to eat, when to exercise, and determine their insulin dose and timing if required. Additionally, patients and providers are generating vast amounts of data from many sources including electronic medical records, insulin pumps, sensors, glucometers, other wearables, as well as evolving genomic, proteomic, metabolomic and microbiomic data. Multiple digital tools and apps have been developed to assist patients to choose wisely, as well as enhance their compliance by employing motivational tools and incorporating incentives from social media and gaming techniques...
September 5, 2017: Journal of Diabetes
https://www.readbyqxmd.com/read/28870410/choosing-wisely-mentors-sponsors-and-your-kitchen-cabinet
#19
Geraldine McGinty
No abstract text is available yet for this article.
September 1, 2017: Journal of the American College of Radiology: JACR
https://www.readbyqxmd.com/read/28840374/-choosing-wisely-together-in-pain-medicine
#20
EDITORIAL
W Häuser, M Keidel
No abstract text is available yet for this article.
August 24, 2017: Der Schmerz
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